MEDICARE: FLORIDA DENTAL PRACTICES, LLC

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	DN14694	FL

General Provider Information

NPI Number	:	1700030681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DENTAL PRACTICES, LLC

Provider Business Mailing Address
First Line	:	19007 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2475
Country	:	US
Telephone Number	:	813-221-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	19007 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2475
Country	:	US
Telephone Number	:	813-221-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FARDIN ZARE
Credential	:	DDS
Telephone Number	:	813-221-2273

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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