MEDICARE: TRINITY ENDODONTICS OF GREATER ORLANDO

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	302R00000X	Health Maintenance Organization	DN16500	FL

General Provider Information

NPI Number	:	1851722326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY ENDODONTICS OF GREATER ORLANDO

Provider Business Mailing Address
First Line	:	6996 PIAZZA GRANDE AVE STE 204
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8753
Country	:	US
Telephone Number	:	407-521-1977
Fax Number	:	407-521-1876

Provider Business Practice Location Address
First Line	:	6996 PIAZZA GRANDE AVE STE 204
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8753
Country	:	US
Telephone Number	:	407-521-1977
Fax Number	:	407-521-1876

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. TERRYL M. CRAWFORD
Credential	:	D.M.D.,M.S.D.
Telephone Number	:	407-521-1977

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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