MEDICARE: FLORIDA PROSTHODONTICS PA

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	1223P0700X	Prosthodontics	DN17718	FL

General Provider Information

NPI Number	:	1659714095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PROSTHODONTICS PA

Provider Business Mailing Address
First Line	:	2180 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4236
Country	:	US
Telephone Number	:	321-452-3388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4236
Country	:	US
Telephone Number	:	321-452-3388
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUNDEEP R RAWAL
Credential	:	D.M.D.
Telephone Number	:	321-452-3388

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	04/16/2013

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Practice Location Address:

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