MEDICARE: VANNI RUSS STRENTA DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN13548	FL

General Provider Information

NPI Number	:	1992832059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANNI RUSS STRENTA DMD

Provider Business Mailing Address
First Line	:	3914 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-5413
Country	:	US
Telephone Number	:	904-573-9560
Fax Number	:	904-573-9562

Provider Business Practice Location Address
First Line	:	3914 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-5413
Country	:	US
Telephone Number	:	904-573-9560
Fax Number	:	904-573-9562

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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