MEDICARE: SAI ORAL SURGERY

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DN19304	FL

General Provider Information

NPI Number	:	1477917706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAI ORAL SURGERY

Provider Business Mailing Address
First Line	:	1728 DUNLAWTON AVE
Second Line	:	SUITE 3
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2922
Country	:	US
Telephone Number	:	412-913-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 DUNLAWTON AVE
Second Line	:	SUITE 3
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2922
Country	:	US
Telephone Number	:	412-913-8877
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SRAVANTHI GANNE
Credential	:	DDS MD
Telephone Number	:	412-913-8877

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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Directions to “SAI ORAL SURGERY ” Practice Location

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