MEDICARE: MINTY DENTAL STUDIO 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104292283	OTHER		DENTIST

General Provider Information

NPI Number	:	1700372240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINTY DENTAL STUDIO LLC

Provider Business Mailing Address
First Line	:	1261 S FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 S FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7070
Country	:	US
Telephone Number	:	754-999-0320
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	DR. CAMILA DI GIORGIO
Credential	:	DDS
Telephone Number	:	786-612-2980

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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Directions to “MINTY DENTAL STUDIO LLC ” Practice Location

Language	Start Address	Practice Location

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