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JACARANDA SMILES EAST NPI 1043677925


NPI Information

NPI: 1043677925
Provider Name: JACARANDA SMILES EAST
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
10051 PINES BLVD
SUITE C
PEMBROKE PINES, FL
ZIP 33024
Phone: (954) 251-2717
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JACARANDA SMILES EAST is a pediatric dentistry dentist in Pembroke Pines, FL. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. JACARANDA SMILES EAST NPI is 1043677925. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

10051 PINES BLVD
SUITE C
PEMBROKE PINES, FL
ZIP 33024-186
Phone: (954) 251-2717
Fax: (954) 613-4005

The provider's authorized official is Rene Luis Landa .
The authorized official title is Pediatric Dentist and has the following contact phone number (954) 251-2717.

The enumeration date for this NPI number is 1/22/2016 and was last updated on 1/22/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric DentistryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1003557500MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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