MEDICARE: DR. MANUEL CAPIRO 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	122300000X	Dentist	10887	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10887	OTHER	FL	DENTAL LICENSE

General Provider Information

NPI Number	:	1194861930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL CAPIRO DDS

Provider Business Mailing Address
First Line	:	6710 MAIN ST STE 131
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2066
Country	:	US
Telephone Number	:	305-822-4339
Fax Number	:	305-821-1753

Provider Business Practice Location Address
First Line	:	6710 MAIN ST STE 131
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2066
Country	:	US
Telephone Number	:	305-822-4339
Fax Number	:	305-821-1753

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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