| Little Smiles Dental Office #1 | |
|
15495 Eagle Nest Ln Ste 110 Miami Lakes FL 33014-2242 | |
| (305) 698-7566 | |
| (305) 698-7565 |
| Full Name | Little Smiles Dental Office #1 |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 15495 Eagle Nest Ln Ste 110, Miami Lakes, Florida |
| Authorized Official Name and Position | Bayardo C Cortes (OWNER/DENTIST) |
| Authorized Official Contact | 3056987566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Smiles Dental Office #1 15495 Eagle Nest Ln Ste 110 Miami Lakes FL 33014-2242 Ph: (305) 698-7566 | Little Smiles Dental Office #1 15495 Eagle Nest Ln Ste 110 Miami Lakes FL 33014-2242 Ph: (305) 698-7566 |
| NPI Number | 1154608370 |
|---|---|
| Provider Enumeration Date | 11/16/2011 |
| Last Update Date | 11/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154608370 | NPI | - | NPPES |
| 075542703 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN15894 (Florida) | Primary |
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