MEDICARE: PONCE DENTAL OF CORAL GABLES CORP

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	122300000X	Dentist

General Provider Information

NPI Number	:	1245162387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONCE DENTAL OF CORAL GABLES CORP

Provider Business Mailing Address
First Line	:	535 W 55TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2554
Country	:	US
Telephone Number	:	305-774-7273
Fax Number	:	321-400-1370

Provider Business Practice Location Address
First Line	:	3190 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6826
Country	:	US
Telephone Number	:	305-774-7273
Fax Number	:	321-400-1370

Authorized Official
Title or Position	:	DENTIST
Name	:	MALENA LEMUS RAMOS
Credential	:	DMD
Telephone Number	:	786-614-6145

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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