MEDICARE: DR. NICOLE ERAZO DDS, MPH

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	1223P0221X	Pediatric Dentistry	DN22409	FL

General Provider Information

NPI Number	:	1760839278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE ERAZO DDS, MPH

Provider Business Mailing Address
First Line	:	1440 NW NORTH RIVER DR STE 345
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2894
Country	:	US
Telephone Number	:	786-353-9887
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 NW NORTH RIVER DR STE 345
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2894
Country	:	US
Telephone Number	:	786-353-9887
Fax Number	:

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/04/2026

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