MEDICARE: HOUSE OF DENTISTRY

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	DN 18733	FL

General Provider Information

NPI Number	:	1508241951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF DENTISTRY

Provider Business Mailing Address
First Line	:	1201 NE 26TH ST
Second Line	:	#107
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-1206
Country	:	US
Telephone Number	:	813-476-2919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 NE 13TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1829
Country	:	US
Telephone Number	:	813-476-2919
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY BRYAN HOUSE
Credential	:	DMD
Telephone Number	:	813-476-2919

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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Directions to “HOUSE OF DENTISTRY ” Practice Location

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