MEDICARE: DR. MICHAEL BRADLEY JERGINS 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	DN15034	FL

General Provider Information

NPI Number	:	1578567301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRADLEY JERGINS D.M.D.

Provider Business Mailing Address
First Line	:	5628 CIRCA FISHHAWK BLVD
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-4218
Country	:	US
Telephone Number	:	813-796-7668
Fax Number	:	727-725-4534

Provider Business Practice Location Address
First Line	:	5628 CIRCA FISHHAWK BLVD
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-4218
Country	:	US
Telephone Number	:	813-796-7668
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/20/2024

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