MEDICARE: DR. RYAN LEE CAUDILL DMD, MSD, 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN16680	FL

General Provider Information

NPI Number	:	1669781902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN LEE CAUDILL DMD, MSD, PA

Provider Business Mailing Address
First Line	:	270 N SYKES CREEK PKWY
Second Line	:	SUITE 104
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3492
Country	:	US
Telephone Number	:	321-453-2535
Fax Number	:	321-483-3181

Provider Business Practice Location Address
First Line	:	270 N SYKES CREEK PKWY
Second Line	:	SUITE 104
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3492
Country	:	US
Telephone Number	:	321-453-2535
Fax Number	:	321-483-3181

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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