MEDICARE: DR. LIZ CRISTOFANO D.D.S.

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	0401008233	VA
2	1223G0001X	General Practice Dentistry	DN16147	FL

General Provider Information

NPI Number	:	1629295472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIZ CRISTOFANO D.D.S.

Provider Business Mailing Address
First Line	:	4526 W SWANN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3722
Country	:	US
Telephone Number	:	813-802-8301
Fax Number	:	813-944-3106

Provider Business Practice Location Address
First Line	:	4104 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1721
Country	:	US
Telephone Number	:	813-802-8301
Fax Number	:	813-944-3106

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	10/25/2010

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