MEDICARE: GENTLE TEETH AND BRACES OF WESTON

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	:	1679110100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE TEETH AND BRACES OF WESTON

Provider Business Mailing Address
First Line	:	2751 EXECUTIVE PARK DR STE 204
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3661
Country	:	US
Telephone Number	:	954-217-0288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 WESTON RD
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3214
Country	:	US
Telephone Number	:	954-217-0288
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHANDY SAMUEL
Credential	:	DDS
Telephone Number	:	954-217-0288

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	01/12/2026

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Directions to “GENTLE TEETH AND BRACES OF WESTON ” Practice Location

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