MEDICARE: THE LITTLE ROYALS DENTISTRY FOR KIDS, PLLC

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

General Provider Information

NPI Number	:	1861957342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LITTLE ROYALS DENTISTRY FOR KIDS, PLLC

Provider Business Mailing Address
First Line	:	600 HERITAGE DR STE 110
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-3098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HERITAGE DR STE 110
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-3098
Country	:	US
Telephone Number	:	561-510-1450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SALVATORE COLOMBO
Credential	:	DMD
Telephone Number	:	561-510-1450

Provider Enumeration Date	:	02/08/2019
Last Update Date	:	02/08/2019

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