MEDICARE: EAST BROWARD DENTAL

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	:	1417613092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BROWARD DENTAL

Provider Business Mailing Address
First Line	:	1212 E BROWARD BLVD # 200
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2123
Country	:	US
Telephone Number	:	954-905-2000
Fax Number	:	954-905-1399

Provider Business Practice Location Address
First Line	:	1212 E BROWARD BLVD # 200
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2123
Country	:	US
Telephone Number	:	954-905-2000
Fax Number	:	954-905-1399

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BURAK TASKONAK
Credential	:	DDS
Telephone Number	:	954-905-2000

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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