MEDICARE: HIALEAH DENTAL CENTER PA

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	DN19377	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255628988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIALEAH DENTAL CENTER PA

Provider Business Mailing Address
First Line	:	1518 W 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2923
Country	:	US
Telephone Number	:	305-823-2661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 W 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2923
Country	:	US
Telephone Number	:	305-823-2661
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIK O CALDERON
Credential	:	DMD
Telephone Number	:	305-823-2661

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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Directions to “HIALEAH DENTAL CENTER PA ” Practice Location

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