| Jacaranda Smiles East | |
|
10051 Pines Blvd Suite C Pembroke Pines FL 33024-6186 | |
| (954) 251-2717 | |
| (954) 613-4005 |
| Full Name | Jacaranda Smiles East |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 10051 Pines Blvd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Rene Luis Landa (PEDIATRIC DENTIST) |
| Authorized Official Contact | 9542512717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacaranda Smiles East 10051 Pines Blvd Suite C Pembroke Pines FL 33024-6186 Ph: (954) 251-2717 | Jacaranda Smiles East 10051 Pines Blvd Suite C Pembroke Pines FL 33024-6186 Ph: (954) 251-2717 |
| NPI Number | 1043677925 |
|---|---|
| Provider Enumeration Date | 01/22/2016 |
| Last Update Date | 01/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043677925 | NPI | - | NPPES |
| 003557500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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