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NPI Code Detail

MEDICARE: BEAUTYSMART DERMATOLOGY CLINIC AND MEDICAL SPA LLC

MEDICARE: BEAUTYSMART DERMATOLOGY CLINIC AND MEDICAL SPA LLC
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
1207NS0135XProcedural Dermatology Physician

General Provider Information

NPI Number : 1033639786
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEAUTYSMART DERMATOLOGY CLINIC AND MEDICAL SPA LLC
Provider Business Mailing Address
First Line : 94 S FEDERAL HWY
Second Line :
City : BOCA RATON
State : FL
Zip : 33432-4825
Country : US
Telephone Number : 561-990-7294
Fax Number :
Provider Business Practice Location Address
First Line : 94 S FEDERAL HWY
Second Line :
City : BOCA RATON
State : FL
Zip : 33432-4825
Country : US
Telephone Number : 561-990-7294
Fax Number :
Authorized Official
Title or Position : MANAGING PARTNER
Name : DEANA M CLARK
Credential : CME
Telephone Number : 561-990-7294
Provider Enumeration Date : 06/23/2017
Last Update Date : 07/21/2022

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Directions to “BEAUTYSMART DERMATOLOGY CLINIC AND MEDICAL SPA LLC ” Practice Location

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