MEDICARE: DR. RANDY L GITTESS DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN0007494	FL

General Provider Information

NPI Number	:	1467491084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY L GITTESS DDS

Provider Business Mailing Address
First Line	:	5733 CANTON CV
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5079
Country	:	US
Telephone Number	:	407-699-1200
Fax Number	:	407-699-1095

Provider Business Practice Location Address
First Line	:	5733 CANTON CV
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5079
Country	:	US
Telephone Number	:	407-699-1200
Fax Number	:	407-699-1095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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