MEDICARE: ALL SMILES GENERAL DENTISTRY II, P.A.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366730236	OTHER		NPI NUMBER

General Provider Information

NPI Number	:	1093443905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL SMILES GENERAL DENTISTRY II, P.A.

Provider Business Mailing Address
First Line	:	18360 NW 7TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18360 NW 7TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4410
Country	:	US
Telephone Number	:	305-705-2743
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANNA BERNKRANT
Credential	:
Telephone Number	:	954-483-6933

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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