MEDICARE: PEDIATRIC DENTAL CENTER OF RIVER LANDING

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
2	1223P0221X	Pediatric Dentistry

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	:	1215518824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL CENTER OF RIVER LANDING

Provider Business Mailing Address
First Line	:	1440 NW NORTH RIVER DR STE 345
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2894
Country	:	US
Telephone Number	:	786-368-6212
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 NW NORTH RIVER DR STE 345
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2894
Country	:	US
Telephone Number	:	786-368-6212
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	ENRIQUE ACOSTA
Credential	:	DDS
Telephone Number	:	786-353-9887

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	06/04/2024

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Directions to “PEDIATRIC DENTAL CENTER OF RIVER LANDING ” Practice Location

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