| Fortune Smiles Inc | |
|
2879 S University Dr Davie FL 33328-1440 | |
| (954) 474-2499 | |
| (954) 474-1966 |
| Full Name | Fortune Smiles Inc |
|---|---|
| Speciality | Dentist |
| Location | 2879 S University Dr, Davie, Florida |
| Authorized Official Name and Position | Madelene Michelle Trujillo (DENTIST) |
| Authorized Official Contact | 3052599120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortune Smiles Inc 2879 S University Dr Davie FL 33328-1440 Ph: (954) 474-2499 | Fortune Smiles Inc 2879 S University Dr Davie FL 33328-1440 Ph: (954) 474-2499 |
| NPI Number | 1982077939 |
|---|---|
| Provider Enumeration Date | 11/12/2015 |
| Last Update Date | 11/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982077939 | NPI | - | NPPES |
| 013776 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D18770 (Florida) | Primary |
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