MEDICARE: DR. FRANK CLINTON DIEFENDERFER D.D.S., P.A.

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		WV

General Provider Information

NPI Number	:	1487667119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK CLINTON DIEFENDERFER D.D.S., P.A.

Provider Business Mailing Address
First Line	:	308 E PAR ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4042
Country	:	US
Telephone Number	:	407-898-8311
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E PAR AVE.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4042
Country	:	US
Telephone Number	:	407-898-8311
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/21/2022

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