MEDICARE: LIL' TEETH BY OLOPH PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528527504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIL' TEETH BY OLOPH PLLC

Provider Business Mailing Address
First Line	:	17040 AYERS RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34604-6806
Country	:	US
Telephone Number	:	352-593-0545
Fax Number	:	844-290-8521

Provider Business Practice Location Address
First Line	:	17040 AYERS RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34604-6806
Country	:	US
Telephone Number	:	352-593-0545
Fax Number	:	844-290-8521

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MADELINE D BERK
Credential	:	DMD
Telephone Number	:	352-537-5027

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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