MEDICARE: JOHANN RAMKISSOON, PLLC

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	21272	FL
2	122300000X	Dentist

General Provider Information

NPI Number	:	1710497862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHANN RAMKISSOON, PLLC

Provider Business Mailing Address
First Line	:	255 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-7050
Country	:	US
Telephone Number	:	386-752-2480
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-7050
Country	:	US
Telephone Number	:	386-752-2480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHANN RAMKISSOON
Credential	:	DMD
Telephone Number	:	386-752-2480

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	05/03/2023

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