MEDICARE: DR. SANDY S TERMOTTO 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	1223G0001X	General Practice Dentistry	8091	GA

General Provider Information

NPI Number	:	1710047774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDY S TERMOTTO D.M.D.

Provider Business Mailing Address
First Line	:	11706 MERCY BLVD
Second Line	:	SUITE 2
City	:	SAVANNAH
State	:	GA
Zip	:	31419-1751
Country	:	US
Telephone Number	:	912-925-3400
Fax Number	:	912-925-2146

Provider Business Practice Location Address
First Line	:	11706 MERCY BLVD
Second Line	:	SUITE 2
City	:	SAVANNAH
State	:	GA
Zip	:	31419-1751
Country	:	US
Telephone Number	:	912-925-3400
Fax Number	:	912-925-2146

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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