MEDICARE: A O D DENTAL CLINIC

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	7784	FL

General Provider Information

NPI Number	:	1568613966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A O D DENTAL CLINIC

Provider Business Mailing Address
First Line	:	2901 S BAYSHORE DR APT 4F
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-6001
Country	:	US
Telephone Number	:	305-476-0230
Fax Number	:

Provider Business Practice Location Address
First Line	:	11865 SW 26TH ST STE G10
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2471
Country	:	US
Telephone Number	:	305-222-1150
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABEL O DE ANNA
Credential	:	D.M.D.
Telephone Number	:	305-222-1150

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/02/2008

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Directions to “A O D DENTAL CLINIC ” Practice Location

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