MEDICARE: DR. PABLO ROBERTO PRADO D.M.D.

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	DN21250	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

General Provider Information

NPI Number	:	1104207703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO ROBERTO PRADO D.M.D.

Provider Business Mailing Address
First Line	:	10075 JOG RD, SUITE #102
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437
Country	:	US
Telephone Number	:	561-244-7022
Fax Number	:

Provider Business Practice Location Address
First Line	:	10075 S JOG RD STE 102
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3532
Country	:	US
Telephone Number	:	561-244-7022
Fax Number	:

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

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	07/21/2022

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