MEDICARE: GATEWAY DENTAL INC

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	1223G0001X	General Practice Dentistry	DN15212	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	:	1396150199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY DENTAL INC

Provider Business Mailing Address
First Line	:	1800 W 68TH ST STE 115
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4406
Country	:	US
Telephone Number	:	305-856-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W 68TH ST STE 115
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4406
Country	:	US
Telephone Number	:	305-856-2300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PABLO MIRANDA
Credential	:	DMD
Telephone Number	:	305-856-2300

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	04/21/2026

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Directions to “GATEWAY DENTAL INC ” Practice Location

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