MEDICARE: PYG DENTAL MANAGEMENT

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	DN15530	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285896159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PYG DENTAL MANAGEMENT

Provider Business Mailing Address
First Line	:	1600 N STATE ROAD 7 STE 400
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5853
Country	:	US
Telephone Number	:	954-581-9228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N STATE ROAD 7 STE 400
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5853
Country	:	US
Telephone Number	:	954-581-9228
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. PETER J GANGI
Credential	:
Telephone Number	:	954-581-9228

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/01/2008

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Directions to “PYG DENTAL MANAGEMENT ” Practice Location

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