MEDICARE: GLOBAL DENTISTRY GROUP CORP

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	:	1952140899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL DENTISTRY GROUP CORP

Provider Business Mailing Address
First Line	:	3500 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5540
Country	:	US
Telephone Number	:	786-953-5978
Fax Number	:	786-953-5973

Provider Business Practice Location Address
First Line	:	3500 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5540
Country	:	US
Telephone Number	:	786-953-5978
Fax Number	:	786-953-5973

Authorized Official
Title or Position	:	OWNER
Name	:	JANY DIAZ
Credential	:	D.M.D
Telephone Number	:	786-406-9241

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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Directions to “GLOBAL DENTISTRY GROUP CORP ” Practice Location

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