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NPI Code Detail

MEDICARE: LIFE SMILE DENTAL GROUP, INC.

MEDICARE: LIFE SMILE DENTAL GROUP, 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
11223E0200XEndodontics
21223P0106XOral and Maxillofacial Pathology Dentistry
31223P0300XPeriodontics
41223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
51223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1588361505
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE SMILE DENTAL GROUP, INC.
Provider Business Mailing Address
First Line : 2438 W 60TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33016-4400
Country : US
Telephone Number : 305-558-6832
Fax Number : 305-558-1159
Provider Business Practice Location Address
First Line : 2438 W 60TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33016-4400
Country : US
Telephone Number : 305-558-6832
Fax Number : 305-558-1159
Authorized Official
Title or Position : GENERAL DENTIST
Name : EDGAR E NAVARRETE
Credential : DMD
Telephone Number : 305-558-6832
Provider Enumeration Date : 02/09/2023
Last Update Date : 02/09/2023

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Directions to “LIFE SMILE DENTAL GROUP, INC. ” Practice Location

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