MEDICARE: FLORIDA DENTAL & DENTURE CENTER 1V

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	13168	FL

General Provider Information

NPI Number	:	1790009728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DENTAL & DENTURE CENTER 1V

Provider Business Mailing Address
First Line	:	1622 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6645
Country	:	US
Telephone Number	:	561-582-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6645
Country	:	US
Telephone Number	:	561-582-3331
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YVES SEMEAH
Credential	:	DDS
Telephone Number	:	561-582-3331

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/19/2010

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