MEDICARE: CORDICA DENTAL DESIGNS

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	DN15530	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

General Provider Information

NPI Number	:	1477944742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORDICA DENTAL DESIGNS

Provider Business Mailing Address
First Line	:	220 W BRANDON BLVD
Second Line	:	STE 106
City	:	BRANDON
State	:	FL
Zip	:	33511-5104
Country	:	US
Telephone Number	:	813-661-1800
Fax Number	:	813-661-1300

Provider Business Practice Location Address
First Line	:	220 W BRANDON BLVD
Second Line	:	STE 106
City	:	BRANDON
State	:	FL
Zip	:	33511-5104
Country	:	US
Telephone Number	:	813-661-1800
Fax Number	:	813-661-1300

Authorized Official
Title or Position	:	DOCTOR, DMD/PRESIDENT
Name	:	DR. ELIZABETH PEREZ
Credential	:	DMD
Telephone Number	:	813-422-2599

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	09/28/2015

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Directions to “CORDICA DENTAL DESIGNS ” Practice Location

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