MEDICARE: FAMILY AND COSMETIC DENTISTRY OF TEMPLE TERRACE

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	332BC3200X	Customized Equipment (DME)	DN-0014538	FL

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

General Provider Information

NPI Number	:	1023540721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY AND COSMETIC DENTISTRY OF TEMPLE TERRACE

Provider Business Mailing Address
First Line	:	224 BULLARD PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-5512
Country	:	US
Telephone Number	:	813-988-2729
Fax Number	:	813-988-8729

Provider Business Practice Location Address
First Line	:	224 BULLARD PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-5512
Country	:	US
Telephone Number	:	813-988-2729
Fax Number	:	813-988-8729

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS VIVIANA CABRERA
Credential	:
Telephone Number	:	813-988-2729

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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