MEDICARE: ALDAMA DENTAL GROUP PA

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	1223G0001X	General Practice Dentistry	DN 17045	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1802558	OTHER	PA	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	283396	OTHER	FL	CIGNA HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0010211	OTHER	FL	ASSURANT
6	188490	OTHER	FL	COMB BENEFIFITS

General Provider Information

NPI Number	:	1871613927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDAMA DENTAL GROUP PA

Provider Business Mailing Address
First Line	:	1250 NW 119TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33167-3232
Country	:	US
Telephone Number	:	305-677-3450
Fax Number	:	305-677-3449

Provider Business Practice Location Address
First Line	:	1250 NW 119TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33167-3232
Country	:	US
Telephone Number	:	305-677-3450
Fax Number	:	305-677-3449

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. EVELYN ALDAMA-ESPINOSA
Credential	:	D.D.S
Telephone Number	:	305-677-3450

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	02/07/2017

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Directions to “ALDAMA DENTAL GROUP PA ” Practice Location

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