MEDICARE: THE DENTAL LOFT LLC

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	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1992656524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTAL LOFT LLC

Provider Business Mailing Address
First Line	:	4800 NE 20TH TER STE 215
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4510
Country	:	US
Telephone Number	:	954-399-1985
Fax Number	:	954-999-0962

Provider Business Practice Location Address
First Line	:	4800 NE 20TH TER STE 215
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4510
Country	:	US
Telephone Number	:	954-399-1985
Fax Number	:	954-999-0962

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. CESAR JULIAN HERNANDEZ
Credential	:	DDS
Telephone Number	:	954-399-1985

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “THE DENTAL LOFT LLC ” Practice Location

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