MEDICARE: DR. JORGE ADALBERTO CHAMORRO 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	122300000X	Dentist	FL.DN 0012620	FL

General Provider Information

NPI Number	:	1952548422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE ADALBERTO CHAMORRO D.D.S.

Provider Business Mailing Address
First Line	:	8613 OLD KINGS RD S STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4845
Country	:	US
Telephone Number	:	904-731-3889
Fax Number	:	904-731-3912

Provider Business Practice Location Address
First Line	:	8613 OLD KINGS RD S STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4845
Country	:	US
Telephone Number	:	904-731-3889
Fax Number	:	904-731-3912

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

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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