MEDICARE: DR. KAMIN BHUPEN TALATI DMD

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	DN16082	FL

General Provider Information

NPI Number	:	1861429185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMIN BHUPEN TALATI DMD

Provider Business Mailing Address
First Line	:	638 SW BAYSHORE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1822
Country	:	US
Telephone Number	:	772-871-8959
Fax Number	:	772-871-5793

Provider Business Practice Location Address
First Line	:	638 SW BAYSHORE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1822
Country	:	US
Telephone Number	:	772-871-8959
Fax Number	:	772-871-5793

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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