MEDICARE: ABC DENTAL, LLP

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	DN15370	FL

General Provider Information

NPI Number	:	1063620821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC DENTAL, LLP

Provider Business Mailing Address
First Line	:	2410 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5124
Country	:	US
Telephone Number	:	954-757-5353
Fax Number	:	954-757-5359

Provider Business Practice Location Address
First Line	:	2410 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5124
Country	:	US
Telephone Number	:	954-757-5353
Fax Number	:	954-757-5359

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MICHAEL BENHAMU
Credential	:
Telephone Number	:	954-757-5353

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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