MEDICARE: ATLANTIC DENTAL SERVICES 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1912605734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC DENTAL SERVICES INC.

Provider Business Mailing Address
First Line	:	8401 VAN NUYS BLVD UNIT 26
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3360
Country	:	US
Telephone Number	:	818-891-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 VAN NUYS BLVD UNIT 26
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3360
Country	:	US
Telephone Number	:	818-891-6900
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAMS SARAIVA
Credential	:
Telephone Number	:	818-891-6900

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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