MEDICARE: KIDS HEALTHY SMILES 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1225543705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS HEALTHY SMILES LLC

Provider Business Mailing Address
First Line	:	2722 NE 1ST ST STE 1
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4934
Country	:	US
Telephone Number	:	954-590-8454
Fax Number	:	754-220-6162

Provider Business Practice Location Address
First Line	:	2722 NE 1ST ST STE 1
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4934
Country	:	US
Telephone Number	:	954-590-8454
Fax Number	:	754-220-6162

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ERIKA GRANADA RAMIREZ
Credential	:	DDS
Telephone Number	:	954-590-8454

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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Directions to “KIDS HEALTHY SMILES LLC ” Practice Location

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