MEDICARE: BILL MARCHESE, PL

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	DN 7455	FL

General Provider Information

NPI Number	:	1457720369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILL MARCHESE, PL

Provider Business Mailing Address
First Line	:	315 W CALL ST
Second Line	:
City	:	STARKE
State	:	FL
Zip	:	32091-3113
Country	:	US
Telephone Number	:	904-964-7501
Fax Number	:	904-964-7503

Provider Business Practice Location Address
First Line	:	315 W CALL ST
Second Line	:
City	:	STARKE
State	:	FL
Zip	:	32091-3113
Country	:	US
Telephone Number	:	904-964-7501
Fax Number	:	904-964-7503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM MARCHESE
Credential	:	DMD
Telephone Number	:	904-964-7501

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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