MEDICARE: FLORIDA DENTAL & DENTURE CTR. 111

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922338011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DENTAL & DENTURE CTR. 111

Provider Business Mailing Address
First Line	:	2945 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4522
Country	:	US
Telephone Number	:	561-844-0033
Fax Number	:	561-844-1486

Provider Business Practice Location Address
First Line	:	2945 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4522
Country	:	US
Telephone Number	:	561-844-0033
Fax Number	:	561-844-1486

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YVES SEMEAH
Credential	:	D.S.
Telephone Number	:	561-844-0033

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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