MEDICARE: PLANES DENTAL ARTS OF PORT SAINT LUCIE

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	DN20254	FL

General Provider Information

NPI Number	:	1487020319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANES DENTAL ARTS OF PORT SAINT LUCIE

Provider Business Mailing Address
First Line	:	10157 S FEDERAL HWY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10157 S FEDERAL HWY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5609
Country	:	US
Telephone Number	:	772-231-6004
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALEX A PLANES
Credential	:	DDS
Telephone Number	:	772-231-6004

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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