MEDICARE: DR. GERALD LABODA 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN2933	FL

General Provider Information

NPI Number	:	1528027844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD LABODA D.M.D.

Provider Business Mailing Address
First Line	:	5285 SUMMERLIN RD
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7602
Country	:	US
Telephone Number	:	239-938-3020
Fax Number	:	239-936-1139

Provider Business Practice Location Address
First Line	:	5285 SUMMERLIN RD
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7602
Country	:	US
Telephone Number	:	239-938-3020
Fax Number	:	239-936-1139

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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