MEDICARE: DENTY US FL DMD,PA

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	261QD0000X	Dental Clinic/Center

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	:	1649767690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTY US FL DMD,PA

Provider Business Mailing Address
First Line	:	2763 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2137
Country	:	US
Telephone Number	:	561-429-4645
Fax Number	:	561-429-4699

Provider Business Practice Location Address
First Line	:	2763 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2137
Country	:	US
Telephone Number	:	561-429-4645
Fax Number	:	561-429-4699

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YUSEL MESA ESTEVEZ
Credential	:	DMD
Telephone Number	:	561-429-4645

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	04/16/2018

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Directions to “DENTY US FL DMD,PA ” Practice Location

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