MEDICARE: DR. CARLOS J GURREONERO 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	122300000X	Dentist	DN 17424	FL

General Provider Information

NPI Number	:	1720200462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS J GURREONERO D.M.D.

Provider Business Mailing Address
First Line	:	8865 COMMODITY CIR
Second Line	:	SUITE #6
City	:	ORLANDO
State	:	FL
Zip	:	32819-9077
Country	:	US
Telephone Number	:	407-219-5931
Fax Number	:

Provider Business Practice Location Address
First Line	:	8865 COMMODITY CIR
Second Line	:	SUITE #6
City	:	ORLANDO
State	:	FL
Zip	:	32819-9077
Country	:	US
Telephone Number	:	407-219-5931
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/29/2012

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