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NPI Code Detail

MEDICARE: EAST COAST FAMILY DENTAL LAUDERDALE PA

MEDICARE: EAST COAST FAMILY DENTAL LAUDERDALE PA
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
11223G0001XGeneral Practice DentistryDN11150FL

General Provider Information

NPI Number : 1053762898
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST COAST FAMILY DENTAL LAUDERDALE PA
Provider Business Mailing Address
First Line : 6741 SW 24TH ST
Second Line : SUITE 14
City : MIAMI
State : FL
Zip : 33155-1762
Country : US
Telephone Number : 305-264-0747
Fax Number : 305-264-0595
Provider Business Practice Location Address
First Line : 4358 N FEDERAL HWY
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33308-5208
Country : US
Telephone Number : 954-776-3320
Fax Number : 954-776-4536
Authorized Official
Title or Position : CEO
Name : MIGUEL REYES
Credential : DDS
Telephone Number : 305-264-0747
Provider Enumeration Date : 06/23/2016
Last Update Date : 06/23/2016

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Directions to “EAST COAST FAMILY DENTAL LAUDERDALE PA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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