MEDICARE: PIMENDENT II, 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	1223G0001X	General Practice Dentistry	17338	FL

General Provider Information

NPI Number	:	1700203528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIMENDENT II, PA

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 DUNLAWTON AVE STE 101
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2925
Country	:	US
Telephone Number	:	386-233-3040
Fax Number	:	386-756-8810

Authorized Official
Title or Position	:	VP INS OPS
Name	:	AMY MARKO
Credential	:
Telephone Number	:	315-454-6000

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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Directions to “PIMENDENT II, PA ” Practice Location

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