MEDICARE: EAST RIVER INTERNATIONAL

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	:	1407041049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST RIVER INTERNATIONAL

Provider Business Mailing Address
First Line	:	555 WASHINGTON AVE
Second Line	:	SUITE350
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-6607
Country	:	US
Telephone Number	:	305-604-5707
Fax Number	:

Provider Business Practice Location Address
First Line	:	13757 SW 152ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-8125
Country	:	US
Telephone Number	:	305-234-9737
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING / INSURANCE
Name	:	TAMARA CUEVAS
Credential	:
Telephone Number	:	305-923-2943

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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Directions to “EAST RIVER INTERNATIONAL ” Practice Location

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