MEDICARE: DR. NIKOLA E GORANOV D.M.D.

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	DN 17616	FL

General Provider Information

NPI Number	:	1508892712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKOLA E GORANOV D.M.D.

Provider Business Mailing Address
First Line	:	8801 COLLEGE PKWY STE 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4882
Country	:	US
Telephone Number	:	239-226-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 COLLEGE PKWY STE 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4882
Country	:	US
Telephone Number	:	239-226-0023
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/08/2015

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