MEDICARE: MRS. MARIA BOUTSIKOS DMD

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	122300000X	Dentist	DN19144	FL

General Provider Information

NPI Number	:	1588977623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA BOUTSIKOS DMD

Provider Business Mailing Address
First Line	:	3480 N PARK RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2526
Country	:	US
Telephone Number	:	954-610-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 W OAKLAND PARK BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-7107
Country	:	US
Telephone Number	:	954-742-5055
Fax Number	:	954-742-5341

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

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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