MEDICARE: MR. MICHAEL TUNICK 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	DN4185	FL

General Provider Information

NPI Number	:	1881010007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL TUNICK D.D.S

Provider Business Mailing Address
First Line	:	4030 SHERIDAN STREET
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3536
Country	:	US
Telephone Number	:	954-966-6410
Fax Number	:	954-966-2094

Provider Business Practice Location Address
First Line	:	4030 SHERIDAN ST
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3536
Country	:	US
Telephone Number	:	954-966-6410
Fax Number	:	954-966-2094

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

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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