MEDICARE: ARTISA DENTAL

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376211060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISA DENTAL

Provider Business Mailing Address
First Line	:	1865 N CORPORATE LAKES BLVD STE 2B
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3273
Country	:	US
Telephone Number	:	954-471-1824
Fax Number	:	954-928-9171

Provider Business Practice Location Address
First Line	:	1865 N CORPORATE LAKES BLVD STE 2B
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3273
Country	:	US
Telephone Number	:	954-928-9192
Fax Number	:	954-928-9171

Authorized Official
Title or Position	:	LEADING DENTIST
Name	:	DR. NATALIA MATUTE
Credential	:	DDS
Telephone Number	:	954-471-1824

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	02/06/2025

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