MEDICARE: MRS. MARITZA SEOANE DDS

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	122300000X	Dentist	0014220	FL

General Provider Information

NPI Number	:	1700134194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARITZA SEOANE DDS

Provider Business Mailing Address
First Line	:	2959 ALAFAYA TRL
Second Line	:	SUITE 109
City	:	OVIEDO
State	:	FL
Zip	:	32765-9482
Country	:	US
Telephone Number	:	407-366-2363
Fax Number	:	407-366-9564

Provider Business Practice Location Address
First Line	:	2959 ALAFAYA TRL
Second Line	:	SUITE 109
City	:	OVIEDO
State	:	FL
Zip	:	32765-9482
Country	:	US
Telephone Number	:	407-366-2363
Fax Number	:	407-366-9564

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

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	10/27/2014

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