MEDICARE: MOREL ESPINAL DENTISTRY, PA

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1992664437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOREL ESPINAL DENTISTRY, PA

Provider Business Mailing Address
First Line	:	5720 FOX HOLLOW DR APT C
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-8928
Country	:	US
Telephone Number	:	917-703-8220
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 SE MIZNER BLVD STE 216
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-6086
Country	:	US
Telephone Number	:	561-338-5005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOMINIC MOREL-MAYNARD
Credential	:	DMD
Telephone Number	:	917-703-8220

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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