MEDICARE: FAMILY DENTISTRY OF HERNANDO, INC

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

General Provider Information

NPI Number	:	1598203440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTISTRY OF HERNANDO, INC

Provider Business Mailing Address
First Line	:	5080 COMMERCIAL WAY
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-1929
Country	:	US
Telephone Number	:	352-596-7388
Fax Number	:	352-596-7174

Provider Business Practice Location Address
First Line	:	5080 COMMERCIAL WAY
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-1929
Country	:	US
Telephone Number	:	352-596-7388
Fax Number	:	352-596-7174

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR/OWNER
Name	:	MRS. TAMMY S WEBER
Credential	:
Telephone Number	:	352-596-7388

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/10/2017

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