MEDICARE: ANGELA DEFABRIQUE 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN 15807	FL

General Provider Information

NPI Number	:	1265526727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DEFABRIQUE DMD

Provider Business Mailing Address
First Line	:	1019 N STATE ROAD 7
Second Line	:	SUITE A
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5100
Country	:	US
Telephone Number	:	561-422-3360
Fax Number	:	561-422-3233

Provider Business Practice Location Address
First Line	:	1019 N STATE ROAD 7
Second Line	:	SUITE A
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5100
Country	:	US
Telephone Number	:	561-422-3360
Fax Number	:	561-422-3233

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/26/2016

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