Healthcare Provider Details

I. General information

NPI: 1801159769
Provider Name (Legal Business Name): MAYLI ASUNCION ESPEJO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 06/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18851 NE 29TH AVE SUITE 300
AVENTURA FL
33180-2808
US

IV. Provider business mailing address

15950 NW 83RD AVE
MIAMI LAKES FL
33016-6627
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-1415
  • Fax: 305-933-1920
Mailing address:
  • Phone: 305-283-0167
  • Fax: 305-557-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: