MEDICARE: LUZARDO DENTAL LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1598361115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUZARDO DENTAL LLC

Provider Business Mailing Address
First Line	:	7940 SW 163RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3427
Country	:	US
Telephone Number	:	305-890-3180
Fax Number	:

Provider Business Practice Location Address
First Line	:	6933 W COMMERCIAL BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2119
Country	:	US
Telephone Number	:	954-724-8486
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. FLOR LUZARDO
Credential	:	DDS
Telephone Number	:	786-451-9171

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/11/2020

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Directions to “LUZARDO DENTAL LLC ” Practice Location

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