MEDICARE: CLEAR SMILES HOLDINGS LLC

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

General Provider Information

NPI Number	:	1730891136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR SMILES HOLDINGS LLC

Provider Business Mailing Address
First Line	:	12169 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-1727
Country	:	US
Telephone Number	:	954-505-3269
Fax Number	:	954-589-0810

Provider Business Practice Location Address
First Line	:	1261 S FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7070
Country	:	US
Telephone Number	:	754-225-1001
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DANIEL RODRIGUEZ
Credential	:
Telephone Number	:	954-505-3269

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	04/13/2023

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