MEDICARE: ELIZABETH MARIE DE AGUIRRE DDS

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	122300000X	Dentist	DN0015008	FL

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
2	1003893363	OTHER		NPI FOR EXPERT SMILES OFFICE
3	1225316888	OTHER	FL	NPI FOR GABLES OFFICE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467434746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARIE DE AGUIRRE DDS

Provider Business Mailing Address
First Line	:	2750 W 68TH ST
Second Line	:	SUITE 108
City	:	HIALEAH
State	:	FL
Zip	:	33016-5446
Country	:	US
Telephone Number	:	305-826-3255
Fax Number	:	305-826-3898

Provider Business Practice Location Address
First Line	:	806 S DOUGLAS RD
Second Line	:	150
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3157
Country	:	US
Telephone Number	:	305-446-2226
Fax Number	:	305-446-8458

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	05/18/2017

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