MEDICARE: CAMILA REIS PEREIRA DI GIORGIO

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	DN23074	FL

General Provider Information

NPI Number	:	1104292283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILA REIS PEREIRA DI GIORGIO

Provider Business Mailing Address
First Line	:	1261 S FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7070
Country	:	US
Telephone Number	:	754-225-1001
Fax Number	:	754-225-1001

Provider Business Practice Location Address
First Line	:	1261 S FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7070
Country	:	US
Telephone Number	:	754-225-1001
Fax Number	:	754-225-1001

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	03/15/2021

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