MEDICARE: BAYARDO CARLOS CORTES 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	1223P0221X	Pediatric Dentistry	DN15894	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174604896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAYARDO CARLOS CORTES DMD

Provider Business Mailing Address
First Line	:	12420 SW 22ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-7703
Country	:	US
Telephone Number	:	786-218-7801
Fax Number	:

Provider Business Practice Location Address
First Line	:	3469 W BOYNTON BEACH BLVD
Second Line	:	STE 20
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4611
Country	:	US
Telephone Number	:	561-736-8755
Fax Number	:	561-736-3996

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/09/2015

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