MEDICARE: EUGENE & LAUREN KRAVITZ

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	:	1750607479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE & LAUREN KRAVITZ

Provider Business Mailing Address
First Line	:	18482 NW 67TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3440
Country	:	US
Telephone Number	:	305-822-9696
Fax Number	:	305-824-9560

Provider Business Practice Location Address
First Line	:	18482 NW 67TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3440
Country	:	US
Telephone Number	:	305-822-9696
Fax Number	:	305-824-9560

Authorized Official
Title or Position	:	DENTIST
Name	:	EUGENE KRAVITZ
Credential	:	DDS
Telephone Number	:	305-822-9696

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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