MEDICARE: ADVANCED AESTHETIC DENTISTRY OF CORAL SPRINGS

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		FL
2	1223G0001X	General Practice Dentistry		FL

General Provider Information

NPI Number	:	1184004004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED AESTHETIC DENTISTRY OF CORAL SPRINGS

Provider Business Mailing Address
First Line	:	1314 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6623
Country	:	US
Telephone Number	:	954-755-3337
Fax Number	:	954-755-3230

Provider Business Practice Location Address
First Line	:	1314 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6623
Country	:	US
Telephone Number	:	954-755-3337
Fax Number	:	954-755-3230

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANATOLY RIPA
Credential	:	DDS
Telephone Number	:	954-755-3337

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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Directions to “ADVANCED AESTHETIC DENTISTRY OF CORAL SPRINGS ” Practice Location

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