MEDICARE: LITTLE SMILES DENTAL OFFICE # 3

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	261QD0000X	Dental Clinic/Center	DN15894	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	:	1215296298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE SMILES DENTAL OFFICE # 3

Provider Business Mailing Address
First Line	:	3469 W BOYNTON BEACH BLVD
Second Line	:	SUITE NUMBER 20
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4611
Country	:	US
Telephone Number	:	561-736-8755
Fax Number	:	561-736-3996

Provider Business Practice Location Address
First Line	:	3469 W BOYNTON BEACH BLVD
Second Line	:	SUITE NUMBER 20
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4611
Country	:	US
Telephone Number	:	561-736-8755
Fax Number	:	561-736-3996

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BAYARDO C CORTES
Credential	:	DMD
Telephone Number	:	305-698-7566

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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Directions to “LITTLE SMILES DENTAL OFFICE # 3 ” Practice Location

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