MEDICARE: JVL DENTAL CREATIONS, PA

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
2	1223P0300X	Periodontics

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	:	1851748149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JVL DENTAL CREATIONS, PA

Provider Business Mailing Address
First Line	:	10271 SW 72ND ST # D106
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3024
Country	:	US
Telephone Number	:	305-595-5655
Fax Number	:

Provider Business Practice Location Address
First Line	:	10271 SW 72ND ST # D106
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3024
Country	:	US
Telephone Number	:	305-595-5655
Fax Number	:

Authorized Official
Title or Position	:	PERIODONTIST/VICEPRESIDENT
Name	:	DR. JUDITH LUBIN
Credential	:	DMD
Telephone Number	:	305-595-5655

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	05/17/2016

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