MEDICARE: PEDIATRIC DENTAL CENTER OF BISCAYNE INC

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	DN17284	FL
2	1223P0221X	Pediatric Dentistry	DN17284	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	:	1154853927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL CENTER OF BISCAYNE INC

Provider Business Mailing Address
First Line	:	2645 S DOUGLAS RD
Second Line	:	SUITE # 703
City	:	MIAMI
State	:	FL
Zip	:	33133-2754
Country	:	US
Telephone Number	:	305-448-3228
Fax Number	:	305-447-8828

Provider Business Practice Location Address
First Line	:	557 NE 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-4519
Country	:	US
Telephone Number	:	786-368-6212
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ENRIQUE ACOSTA
Credential	:	D.D.S,M.B.A
Telephone Number	:	786-368-6212

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	04/20/2017

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