MEDICARE: MIRAMAR DENTAL ASSOCIATES

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	DN5336	FL

General Provider Information

NPI Number	:	1386703890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRAMAR DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2231 NORTH UNIVERSITY DRIVE
Second Line	:	SUITE A
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024
Country	:	US
Telephone Number	:	954-981-5600
Fax Number	:	954-981-1293

Provider Business Practice Location Address
First Line	:	2231 NORTH UNIVERSITY DRIVE
Second Line	:	SUITE A
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024
Country	:	US
Telephone Number	:	954-981-5600
Fax Number	:	954-981-1293

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. JEROME ALAN SOLOMAN
Credential	:	DDS
Telephone Number	:	954-981-5600

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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