MEDICARE: C-BAR DENTAL,LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1205371259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C-BAR DENTAL,LLC

Provider Business Mailing Address
First Line	:	1702 S DIXIE HWY
Second Line	:	SUITE C1
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-5886
Country	:	US
Telephone Number	:	561-223-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 S DIXIE HWY
Second Line	:	SUITE C1
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-5886
Country	:	US
Telephone Number	:	561-223-3501
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE CONSULTANT MANAGER
Name	:	GENESE DEZILME
Credential	:
Telephone Number	:	561-752-6304

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	01/05/2017

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