MEDICARE: K DENTAL CORP

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	DN 21512	FL
2	122300000X	Dentist	DN 21582	FL

General Provider Information

NPI Number	:	1225570963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K DENTAL CORP

Provider Business Mailing Address
First Line	:	13550 SW 88TH ST STE 170
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1543
Country	:	US
Telephone Number	:	305-387-3002
Fax Number	:

Provider Business Practice Location Address
First Line	:	13550 SW 88TH ST STE 170
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1543
Country	:	US
Telephone Number	:	305-387-3002
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. ANA B TORRES BUSTILLO
Credential	:	DMD
Telephone Number	:	305-387-3002

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	11/11/2016

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Directions to “K DENTAL CORP ” Practice Location

Language	Start Address	Practice Location

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