MEDICARE: DENTAL LAS OLAS PA

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	122300000X	Dentist	20436	FL

General Provider Information

NPI Number	:	1265862593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL LAS OLAS PA

Provider Business Mailing Address
First Line	:	900 NE 12TH AVE
Second Line	:	APT 602
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2655
Country	:	US
Telephone Number	:	617-818-4596
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LAS OLAS BLVD
Second Line	:	SUITE #140
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	954-524-6595
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NADEZDA SELMIC
Credential	:	DMD
Telephone Number	:	617-818-4596

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/22/2013

Similar Medicare Providers

1861608218 — NADEZDA SELMIC DMD
Practice Location Address:

401 E LAS OLAS BLVD , SUITE #140
FORT LAUDERDALE, FL
33301-2210

Practice Phone: 617-818-4596
Practice Fax:

1922246610 — BOLANOS-MCMAHAN, LLC.
Practice Location Address:

401 E LAS OLAS BLVD STE 130-451
FORT LAUDERDALE, FL
33301-2210

Practice Phone: 561-891-9148
Practice Fax: 954-607-5852

1174763148 — SOUTH FLORIDA PREMIERE CARDIOLOGY LLC
Practice Location Address:

401 E LAS OLAS BLVD , SUITE 130-137
FORT LAUDERDALE, FL
33301-2210

Practice Phone: 954-616-3627
Practice Fax:

1841423100 — JENNIFER MCMAHAN OTR/L
Practice Location Address:

401 E LAS OLAS BLVD STE 130-451
FORT LAUDERDALE, FL
33301-2210

Practice Phone: 561-891-9148
Practice Fax: 954-607-5852

1215266366 — DR. HENRY JOSEPH COLEMAN D.O.
Practice Location Address:

401 E LAS OLAS BLVD , SUITE 130-153
FORT LAUDERDALE, FL
33301-2210

Practice Phone: 954-272-8425
Practice Fax:

1144519281 — MR. TRAVIS W ATKINSON L.C.S.W.
Practice Location Address:

401 E LAS OLAS BLVD STE 130-733
FORT LAUDERDALE, FL
33301-2210

Practice Phone: 212-725-7774
Practice Fax:

Directions to “DENTAL LAS OLAS PA ” Practice Location

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