MEDICARE: BELLA SMILE DENTAL INC

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	DN17582	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	:	1861805632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA SMILE DENTAL INC

Provider Business Mailing Address
First Line	:	10550 NW 77TH CT STE 220
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2071
Country	:	US
Telephone Number	:	305-556-9473
Fax Number	:	305-556-9486

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT STE 220
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2071
Country	:	US
Telephone Number	:	305-556-9473
Fax Number	:	305-556-9486

Authorized Official
Title or Position	:	OWNER
Name	:	CLARA IVYS RODRIGUEZ
Credential	:
Telephone Number	:	305-556-9473

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/09/2014

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Directions to “BELLA SMILE DENTAL INC ” Practice Location

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