MEDICARE: ATLANTIC COAST PROSTHODONTICS INC

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	332BC3200X	Customized Equipment (DME)
2	1223P0700X	Prosthodontics	DN 10669	FL

General Provider Information

NPI Number	:	1962750935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC COAST PROSTHODONTICS INC

Provider Business Mailing Address
First Line	:	1509 MASON AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4548
Country	:	US
Telephone Number	:	386-239-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 MASON AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4548
Country	:	US
Telephone Number	:	386-239-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN WHITSITT
Credential	:	D.D.S.
Telephone Number	:	386-239-7600

Provider Enumeration Date	:	08/24/2012
Last Update Date	:	08/24/2012

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