MEDICARE: DR. BENJAMIN TINDAL D.M.D

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	DN18456	FL
2	1223P0700X	Prosthodontics	DRP656	FL

General Provider Information

NPI Number	:	1992968465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN TINDAL D.M.D

Provider Business Mailing Address
First Line	:	3909 E BAY DR
Second Line	:
City	:	HOLMES BEACH
State	:	FL
Zip	:	34217-1997
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 E BAY DR
Second Line	:
City	:	HOLMES BEACH
State	:	FL
Zip	:	34217-1997
Country	:	US
Telephone Number	:	941-778-2204
Fax Number	:

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

Provider Enumeration Date	:	07/05/2008
Last Update Date	:	06/06/2011

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Directions to “ DR. BENJAMIN TINDAL D.M.D” Practice Location

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