MEDICARE: POMPANO FAMILY SMILES 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1033936091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMPANO FAMILY SMILES LLC

Provider Business Mailing Address
First Line	:	1531 S CYPRESS RD # B
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-9134
Country	:	US
Telephone Number	:	954-933-1813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 S CYPRESS RD # B
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-9134
Country	:	US
Telephone Number	:	954-933-1813
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REYNALDO NOVOA
Credential	:	DMD
Telephone Number	:	786-444-2700

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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