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General NPI Number Information
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NPI Number | 1306196829
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Entity Type | Organization
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Legal Business Name | TANGO DENTAL PA
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 3015 BAYVIEW DR STE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1710
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Country | US
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Telephone | 954-563-9722
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Fax | 954-563-1912
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Provider Business Mailing Address
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Address Line | 3015 BAYVIEW DR STE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1710
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Country | US
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Telephone | 954-563-9722
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Fax | 954-563-1912
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FEDERICO JAVIER SCHMID HIDALGO
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Credential | DDS
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Telephone | 407-733-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN18919
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License Number State | FL
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