MEDICARE: SOUTH FLORIDA DENTAL CENTER

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

General Provider Information

NPI Number	:	1356935050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA DENTAL CENTER

Provider Business Mailing Address
First Line	:	7522 WILES RD STE 104
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2056
Country	:	US
Telephone Number	:	954-755-7971
Fax Number	:	954-755-7994

Provider Business Practice Location Address
First Line	:	7522 WILES RD STE 104
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2056
Country	:	US
Telephone Number	:	954-755-7971
Fax Number	:	954-755-7994

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL COHEN
Credential	:	DDS
Telephone Number	:	908-217-1731

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	03/06/2021

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