MEDICARE: SOUTH FLORIDA DENTAL CARE

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		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073092284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA DENTAL CARE

Provider Business Mailing Address
First Line	:	922 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3404
Country	:	US
Telephone Number	:	178-654-2970
Fax Number	:	786-542-9690

Provider Business Practice Location Address
First Line	:	922 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3404
Country	:	US
Telephone Number	:	178-654-2970
Fax Number	:	786-542-9690

Authorized Official
Title or Position	:	OWNER
Name	:	WENDY ELIZABETH PINALES SWANSON
Credential	:	DDS
Telephone Number	:	305-409-9397

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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Directions to “SOUTH FLORIDA DENTAL CARE ” Practice Location

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