MEDICARE: CHASE DENTAL SLEEPCARE OF FORT LAUDERDALE CORP

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	DN 18363	FL

General Provider Information

NPI Number	:	1447686001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASE DENTAL SLEEPCARE OF FORT LAUDERDALE CORP

Provider Business Mailing Address
First Line	:	2330 NE 9TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3579
Country	:	US
Telephone Number	:	954-563-5535
Fax Number	:	954-563-8888

Provider Business Practice Location Address
First Line	:	2330 NE 9TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3579
Country	:	US
Telephone Number	:	954-563-5535
Fax Number	:	954-563-8888

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. FABRIZIO AMADOR
Credential	:	DMD
Telephone Number	:	954-563-5535

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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