MEDICARE: PERFECT SMILE AT DADELAND CORP.

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	:	1386509891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECT SMILE AT DADELAND CORP.

Provider Business Mailing Address
First Line	:	9580 SW 40TH ST STE A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4065
Country	:	US
Telephone Number	:	786-631-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	9580 SW 40TH ST STE A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4065
Country	:	US
Telephone Number	:	786-631-3761
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIVEISYS PEDRAZA
Credential	:	DDS
Telephone Number	:	786-337-1013

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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