MEDICARE: ADVANCED DENTAL CARE SPECIALISTS INC

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	:	1497132559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTAL CARE SPECIALISTS INC

Provider Business Mailing Address
First Line	:	13736 LITTLE RD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-8024
Country	:	US
Telephone Number	:	727-869-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	13736 LITTLE RD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-8024
Country	:	US
Telephone Number	:	727-869-3886
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAIME ESTRADA
Credential	:	DDS
Telephone Number	:	727-869-3886

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	04/28/2015

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