MEDICARE: DR. PAUL WITOLD JAKUBOWSKI D.D.S.

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	DN 14187	FL

General Provider Information

NPI Number	:	1790808822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL WITOLD JAKUBOWSKI D.D.S.

Provider Business Mailing Address
First Line	:	260 MOHAWK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-7433
Country	:	US
Telephone Number	:	352-243-2323
Fax Number	:	352-243-2310

Provider Business Practice Location Address
First Line	:	260 MOHAWK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-7433
Country	:	US
Telephone Number	:	352-243-2323
Fax Number	:	352-243-2310

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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