MEDICARE: SMILE PERFECTION DENTAL OF BOYNTON BEACH

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

General Provider Information

NPI Number	:	1649802612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE PERFECTION DENTAL OF BOYNTON BEACH

Provider Business Mailing Address
First Line	:	10075 S JOG RD STE 102
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3532
Country	:	US
Telephone Number	:	561-244-7022
Fax Number	:

Provider Business Practice Location Address
First Line	:	10075 S JOG RD STE 102
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3532
Country	:	US
Telephone Number	:	561-244-7022
Fax Number	:	561-244-7027

Authorized Official
Title or Position	:	OWNER
Name	:	RICARDO CHANG
Credential	:
Telephone Number	:	954-210-7994

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/12/2020

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