MEDICARE: DR. JAMES MICHAEL KILCOYNE 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	1223G0001X	General Practice Dentistry	DN 6028	FL

General Provider Information

NPI Number	:	1972560829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL KILCOYNE DDS

Provider Business Mailing Address
First Line	:	9109 BAYMEADOWS RD
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2014
Country	:	US
Telephone Number	:	904-731-0311
Fax Number	:	904-731-0312

Provider Business Practice Location Address
First Line	:	9109 BAYMEADOWS RD
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2014
Country	:	US
Telephone Number	:	904-731-0311
Fax Number	:	904-731-0312

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/06/2009

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