MEDICARE: DR. DEAN JASON MOURSELAS DDS

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	DN16793	FL

General Provider Information

NPI Number	:	1952495715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN JASON MOURSELAS DDS

Provider Business Mailing Address
First Line	:	501 GOODLETTE RD N
Second Line	:	STE B202
City	:	NAPLES
State	:	FL
Zip	:	34102-5473
Country	:	US
Telephone Number	:	239-530-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 8TH ST S
Second Line	:	SUITE 106
City	:	NAPLES
State	:	FL
Zip	:	34102-6107
Country	:	US
Telephone Number	:	239-261-7291
Fax Number	:	239-261-7291

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/08/2016

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