MEDICARE: DR. DAVID HERSKOWICH D.M.D.

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	DN0013689	FL

General Provider Information

NPI Number	:	1669561205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID HERSKOWICH D.M.D.

Provider Business Mailing Address
First Line	:	19016 NE 29TH AVE
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33180-2823
Country	:	US
Telephone Number	:	305-466-5555
Fax Number	:	305-466-5505

Provider Business Practice Location Address
First Line	:	19016 NE 29TH AVE
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33180-2823
Country	:	US
Telephone Number	:	305-466-5555
Fax Number	:	305-466-5505

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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