MEDICARE: SPIRO JOHN PANTZOULAS DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN17517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730397530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPIRO JOHN PANTZOULAS DMD

Provider Business Mailing Address
First Line	:	926 GREAT POND DR STE 2002
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1096 CYPRESS PKWY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-3328
Country	:	US
Telephone Number	:	407-933-8222
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	05/14/2015

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