Healthcare Provider Details

I. General information

NPI: 1245162387
Provider Name (Legal Business Name): PONCE DENTAL OF CORAL GABLES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 PONCE DE LEON BLVD
CORAL GABLES FL
33134-6826
US

IV. Provider business mailing address

535 W 55TH PL
HIALEAH FL
33012-2554
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-7273
  • Fax: 321-400-1370
Mailing address:
  • Phone: 305-774-7273
  • Fax: 321-400-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MALENA LEMUS RAMOS
Title or Position: DENTIST
Credential: DMD
Phone: 786-614-6145