MEDICARE: DR. ALBERTO ANTONIO DE CARDENAS D.M.D.

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	DN9412	FL

General Provider Information

NPI Number	:	1679653158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERTO ANTONIO DE CARDENAS D.M.D.

Provider Business Mailing Address
First Line	:	8060 NW 155TH ST
Second Line	:	SUITE 200
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5883
Country	:	US
Telephone Number	:	305-821-2752
Fax Number	:	786-439-1348

Provider Business Practice Location Address
First Line	:	8060 NW 155TH ST
Second Line	:	SUITE 200
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5883
Country	:	US
Telephone Number	:	305-821-2752
Fax Number	:	786-439-1348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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