MEDICARE: ZACHARIAS J KALARICKAL D D S P A

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

General Provider Information

NPI Number	:	1841743937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACHARIAS J KALARICKAL D D S P A

Provider Business Mailing Address
First Line	:	28965 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3218
Country	:	US
Telephone Number	:	813-991-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	28965 WESLEY CHAPEL BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3218
Country	:	US
Telephone Number	:	813-991-5100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ZACHARIAS KALARICKAL
Credential	:
Telephone Number	:	813-991-5100

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	11/08/2016

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