MEDICARE: DR. LARRY VINUELA 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN19253	FL

General Provider Information

NPI Number	:	1356515035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY VINUELA DMD

Provider Business Mailing Address
First Line	:	9001 SW 93RD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2066
Country	:	US
Telephone Number	:	305-431-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	15450 NEW BARN RD
Second Line	:	#101
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2169
Country	:	US
Telephone Number	:	305-557-7775
Fax Number	:

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

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	11/04/2014

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