MEDICARE: TONGUE TIE CENTER OF FLORIDA

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	1223P0221X	Pediatric Dentistry	DN16968	FL

General Provider Information

NPI Number	:	1205104809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONGUE TIE CENTER OF FLORIDA

Provider Business Mailing Address
First Line	:	3365 BURNS RD STE 200
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4303
Country	:	US
Telephone Number	:	561-944-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	3365 BURNS RD STE 200
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4303
Country	:	US
Telephone Number	:	561-944-9009
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YURI GOLDVASSER
Credential	:	DDS
Telephone Number	:	561-775-1011

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	10/02/2024

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