MEDICARE: DR. RENAN LEONARDO BUITRAGO D.D.S.

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	1223P0700X	Prosthodontics	DN20567	FL
2	1223P0700X	Prosthodontics	DN014325	GA
3	1223G0001X	General Practice Dentistry	DN20567	FL

General Provider Information

NPI Number	:	1306007547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENAN LEONARDO BUITRAGO D.D.S.

Provider Business Mailing Address
First Line	:	2232 N UNIVERSITY DR STE B
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6184
Country	:	US
Telephone Number	:	917-574-3822
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 N UNIVERSITY DR STE B
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6184
Country	:	US
Telephone Number	:	954-997-5147
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	01/05/2022

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