MEDICARE: MR. CARLOS LOUIS SIERRA

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	DN0012206	FL

General Provider Information

NPI Number	:	1306065875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS LOUIS SIERRA

Provider Business Mailing Address
First Line	:	4001 N OCEAN DR STE 202
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	954-351-6980
Fax Number	:	954-351-7927

Provider Business Practice Location Address
First Line	:	4001 N OCEAN DR STE 202
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	954-351-6980
Fax Number	:	954-351-7927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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