MEDICARE: MBN DENTAL SERVICES

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	261QD0000X	Dental Clinic/Center

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	:	1316104524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBN DENTAL SERVICES

Provider Business Mailing Address
First Line	:	1600 N STATE ROAD 7
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5853
Country	:	US
Telephone Number	:	954-581-7338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N STATE ROAD 7
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5853
Country	:	US
Telephone Number	:	954-581-7338
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ELIZABETH PEREZ FLOWERS
Credential	:	D.M.D
Telephone Number	:	954-581-7338

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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