Julie A Vavruska, DMD
Individual provider Active NPI Dentist · Sumterville, FL
NPI 1992798649 · NPPES record last updated Aug 9, 2007
Key facts
- NPI
- 1992798649
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN15250 (FL)
- Practice address
- 1389 S US Highway 301
Sumterville, FL 33585-5135 - Phone
- (352) 793-5900
- Fax
- (352) 793-6269
- NPI assigned
- Aug 29, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160713001128 | FL | Order and Referring Only - Dentist |
6709178650 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Project Health Inc | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN15250 | FL | Yes |
Addresses
Primary practice location
1389 S US Highway 301
Sumterville, FL 33585-5135
Mailing address
1425 S US Highway 301
Sumterville, FL 33585-5135
Phone (352) 793-5900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057724300 | Other | FL | MEDICAID FEE FOR SERVICE |
| 029547796 | Other | FL | MEDICAID DENTAL |
| 029547700 | Other | FL | MEDICAID FQHC |
| 680013100 | Medicaid | LA |
Other providers in Sumterville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.