MEDICARE: BEAUTIFUL SMILES P.A

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	DN16129	FL

General Provider Information

NPI Number	:	1417289703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL SMILES P.A

Provider Business Mailing Address
First Line	:	227 71ST ST
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 71ST ST
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3209
Country	:	US
Telephone Number	:	305-866-2933
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONIA BAKER
Credential	:
Telephone Number	:	305-866-2933

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	02/11/2010

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