MEDICARE: DR. ANDREAS UDO BESSENROTH 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	DN14155	FL

General Provider Information

NPI Number	:	1801911847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREAS UDO BESSENROTH D.M.D.

Provider Business Mailing Address
First Line	:	4512 N FLAGLER DR
Second Line	:	SUITE 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3839
Country	:	US
Telephone Number	:	561-845-1818
Fax Number	:	561-845-1801

Provider Business Practice Location Address
First Line	:	4512 N FLAGLER DR
Second Line	:	SUITE 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3839
Country	:	US
Telephone Number	:	561-845-1818
Fax Number	:	561-845-1801

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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