MEDICARE: CORAL SPRINGS FAMILY DENTISTRY AT UNIVESITY

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	DN14972	FL

General Provider Information

NPI Number	:	1558519488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL SPRINGS FAMILY DENTISTRY AT UNIVESITY

Provider Business Mailing Address
First Line	:	10800 AVENIDA DEL RIO
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6134
Country	:	US
Telephone Number	:	954-341-4766
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ILYA STEIN
Credential	:	D.M.D.
Telephone Number	:	954-341-4755

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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