MEDICARE: GENTLE TEETH OF CORALSPRINGS AND PARKLAND

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
2	261QD0000X	Dental Clinic/Center	DN17317	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982180725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE TEETH OF CORALSPRINGS AND PARKLAND

Provider Business Mailing Address
First Line	:	5401 N UNIVERSITY DR STE 101
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-344-3932
Fax Number	:	844-260-5713

Provider Business Practice Location Address
First Line	:	5401 N UNIVERSITY DR STE 101
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-344-3932
Fax Number	:	844-260-5713

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SYDNEE SAMUEL
Credential	:
Telephone Number	:	954-344-3932

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	05/24/2022

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Directions to “GENTLE TEETH OF CORALSPRINGS AND PARKLAND ” Practice Location

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