MEDICARE: FIRAS MAROUF DMD

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	1223G0001X	General Practice Dentistry	DN17064	FL

General Provider Information

NPI Number	:	1487665774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIRAS MAROUF DMD

Provider Business Mailing Address
First Line	:	620 W STATE ROAD 434
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5330
Country	:	US
Telephone Number	:	407-327-0731
Fax Number	:	407-327-1018

Provider Business Practice Location Address
First Line	:	620 W STATE ROAD 434
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5330
Country	:	US
Telephone Number	:	407-327-0731
Fax Number	:	407-327-1018

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	11/21/2011

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