MEDICARE: JORGE DONOSO,DDS,MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11580	FL

General Provider Information

NPI Number	:	1255508529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORGE DONOSO,DDS,MS

Provider Business Mailing Address
First Line	:	2127 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6134
Country	:	US
Telephone Number	:	954-341-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2127 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6134
Country	:	US
Telephone Number	:	954-341-1040
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JORGE DONOSO
Credential	:
Telephone Number	:	954-341-1040

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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