MEDICARE: MAGIC LITTLE TEETH CORP

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	1223P0700X	Prosthodontics
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1164151031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGIC LITTLE TEETH CORP

Provider Business Mailing Address
First Line	:	7036 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1603
Country	:	US
Telephone Number	:	305-441-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7036 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1603
Country	:	US
Telephone Number	:	305-441-7700
Fax Number	:

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. FERNANDO PINO RIVERA
Credential	:	DDS
Telephone Number	:	305-588-7545

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/07/2022

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Directions to “MAGIC LITTLE TEETH CORP ” Practice Location

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