MEDICARE: MR. JORGE M RICARDEZ DDS

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	122300000X	Dentist	DN 11679	FL

General Provider Information

NPI Number	:	1083954945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE M RICARDEZ DDS

Provider Business Mailing Address
First Line	:	2330 NE 9TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3579
Country	:	US
Telephone Number	:	954-563-5535
Fax Number	:	954-563-8888

Provider Business Practice Location Address
First Line	:	2330 NE 9TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3579
Country	:	US
Telephone Number	:	954-563-5535
Fax Number	:	954-563-8888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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