MEDICARE: FEDERICO JAVIER SCHMID-HIDALGO D.D.S.

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	DN18919	FL

General Provider Information

NPI Number	:	1407178247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEDERICO JAVIER SCHMID-HIDALGO D.D.S.

Provider Business Mailing Address
First Line	:	3015 BAYVIEW DR STE A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1710
Country	:	US
Telephone Number	:	954-563-9722
Fax Number	:	954-563-1912

Provider Business Practice Location Address
First Line	:	3015 BAYVIEW DR STE A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1710
Country	:	US
Telephone Number	:	954-563-9722
Fax Number	:	954-563-1912

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

Provider Enumeration Date	:	02/21/2010
Last Update Date	:	09/11/2012

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