MEDICARE: ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist
2	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447990742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA

Provider Business Mailing Address
First Line	:	3322 W END AVE STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-6805
Country	:	US
Telephone Number	:	629-999-5014
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 N 9TH AVE UNIT 10-11
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6638
Country	:	US
Telephone Number	:	850-378-1020
Fax Number	:

Authorized Official
Title or Position	:	SMANAGER, LICENSING & CREDENTIALING
Name	:	SHERRIE EDMONDSON
Credential	:
Telephone Number	:	629-999-5014

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	08/08/2023

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Directions to “ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA ” Practice Location

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