MEDICARE: ORAL DENTAL CARE OF FLORIDA

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	122300000X	Dentist	DN21676	FL

General Provider Information

NPI Number	:	1427507763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL DENTAL CARE OF FLORIDA

Provider Business Mailing Address
First Line	:	7210 SW 57TH AVE
Second Line	:	SUITE 204
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5321
Country	:	US
Telephone Number	:	305-665-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 SW 57TH AVE
Second Line	:	SUITE 204
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5321
Country	:	US
Telephone Number	:	305-665-4448
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTOINE FARHA
Credential	:	DDS
Telephone Number	:	305-665-4448

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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