MEDICARE: PLANTATION PALMS DENTAL 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	261QD0000X	Dental Clinic/Center	DN21909	FL

General Provider Information

NPI Number	:	1437667466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANTATION PALMS DENTAL P.A.

Provider Business Mailing Address
First Line	:	1837 N PINE ISLAND RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5207
Country	:	US
Telephone Number	:	954-350-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 N PINE ISLAND RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5207
Country	:	US
Telephone Number	:	954-350-0400
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. GABRIEL SHVETS
Credential	:	DDS
Telephone Number	:	954-350-0400

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	01/11/2018

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