MEDICARE: TAMARAC SMILE CENTER

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

General Provider Information

NPI Number	:	1134901820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMARAC SMILE CENTER

Provider Business Mailing Address
First Line	:	6510 N UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4001
Country	:	US
Telephone Number	:	954-417-4499
Fax Number	:	954-210-8074

Provider Business Practice Location Address
First Line	:	6510 N UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4001
Country	:	US
Telephone Number	:	954-417-4499
Fax Number	:	954-210-8074

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BLANCA CASTELLO
Credential	:
Telephone Number	:	954-850-4367

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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Directions to “TAMARAC SMILE CENTER ” Practice Location

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