MEDICARE: THE DENTAL GROUP

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	DN15860	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN15860	OTHER	FL	LICENSCE NUMBER

General Provider Information

NPI Number	:	1013232511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTAL GROUP

Provider Business Mailing Address
First Line	:	2609 W OAKLAND PARK BLVD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1355
Country	:	US
Telephone Number	:	954-485-1170
Fax Number	:	954-485-5820

Provider Business Practice Location Address
First Line	:	2609 W OAKLAND PARK BLVD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1355
Country	:	US
Telephone Number	:	954-485-1170
Fax Number	:	954-485-5820

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HENRY A RODRIGUEZ-MARTIN
Credential	:	D.M.D.
Telephone Number	:	954-485-1170

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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Directions to “THE DENTAL GROUP ” Practice Location

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