MEDICARE: ORANGE GROVE DENTAL

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	261QD0000X	Dental Clinic/Center	DN18942	FL

General Provider Information

NPI Number	:	1558766097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE GROVE DENTAL

Provider Business Mailing Address
First Line	:	17039 HEART OF PALMS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4122 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6122
Country	:	US
Telephone Number	:	302-290-2133
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MANU MOHAN SACHDEV
Credential	:
Telephone Number	:	302-290-2133

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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