MEDICARE: DR. NICK L KAVOUKLIS D.D.S.

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	DN18263	FL

General Provider Information

NPI Number	:	1508053109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK L KAVOUKLIS D.D.S.

Provider Business Mailing Address
First Line	:	6421 SHELDON ROAD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3102
Country	:	US
Telephone Number	:	813-888-9004
Fax Number	:	813-888-9517

Provider Business Practice Location Address
First Line	:	6421 SHELDON ROAD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3102
Country	:	US
Telephone Number	:	813-888-9004
Fax Number	:	813-888-9517

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

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	05/18/2021

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