MEDICARE: STEVEN CARADIMOS DMD PC

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	DN1855378	MA

General Provider Information

NPI Number	:	1659643989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN CARADIMOS DMD PC

Provider Business Mailing Address
First Line	:	30 HIGGINS CROWELL RD
Second Line	:	SUITE 2
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-3444
Country	:	US
Telephone Number	:	508-771-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 HIGGINS CROWELL RD
Second Line	:	SUITE 2
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-3444
Country	:	US
Telephone Number	:	508-771-1777
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. STEVEN CARADIMOS
Credential	:	DMD
Telephone Number	:	508-771-1777

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	02/02/2012

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