MEDICARE: CM DENTAL GROUP INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568947034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CM DENTAL GROUP INC

Provider Business Mailing Address
First Line	:	1544 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-558-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-558-9222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDUARDO FRANCISCO CABRERA VIERA
Credential	:	DDS
Telephone Number	:	786-554-6108

Provider Enumeration Date	:	09/30/2018
Last Update Date	:	09/30/2018

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