MEDICARE: DENTAL PARTNER GROUP, 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	1223G0001X	General Practice Dentistry	DN20998	FL

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	:	1851842181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PARTNER GROUP, PA

Provider Business Mailing Address
First Line	:	1124 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5019
Country	:	US
Telephone Number	:	305-885-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5019
Country	:	US
Telephone Number	:	305-885-7767
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	MARLEN GUTIERREZ
Credential	:	DDS
Telephone Number	:	305-885-7767

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	10/21/2016

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Directions to “DENTAL PARTNER GROUP, PA ” Practice Location

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