MEDICARE: CONGRESS COSMETIC & GENERAL DENTISTRY 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

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	:	1972891919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONGRESS COSMETIC & GENERAL DENTISTRY INC.

Provider Business Mailing Address
First Line	:	1620 S CONGRESS AVE
Second Line	:	SUITE 102
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2128
Country	:	US
Telephone Number	:	561-434-6661
Fax Number	:	561-434-6662

Provider Business Practice Location Address
First Line	:	1620 S CONGRESS AVE
Second Line	:	SUITE 102
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2128
Country	:	US
Telephone Number	:	561-434-6661
Fax Number	:	561-434-6662

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IDALMIS RAMOS-ABELENDA
Credential	:
Telephone Number	:	561-434-6661

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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