MEDICARE: WHOLE DENTAL DESIGN 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	:	1740757087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE DENTAL DESIGN LLC

Provider Business Mailing Address
First Line	:	1875 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5805
Country	:	US
Telephone Number	:	954-320-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1875 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5805
Country	:	US
Telephone Number	:	954-320-9555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YOLAIVYS VALCARCEL FUNDORA
Credential	:	DMD
Telephone Number	:	786-973-6996

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/24/2018

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Directions to “WHOLE DENTAL DESIGN LLC ” Practice Location

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