MEDICARE: AESTHETIC DENTAL EXPRESSION INC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376218644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETIC DENTAL EXPRESSION INC

Provider Business Mailing Address
First Line	:	14834 SW 45TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14834 SW 45TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4324
Country	:	US
Telephone Number	:	305-979-2119
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	YOSJANY MORA
Credential	:	DDS
Telephone Number	:	786-270-8759

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	08/10/2021

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Directions to “AESTHETIC DENTAL EXPRESSION INC ” Practice Location

Language	Start Address	Practice Location

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