Healthcare Provider Details

I. General information

NPI: 1992962583
Provider Name (Legal Business Name): MURIEL IWANOWSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

IV. Provider business mailing address

5965 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-7702
  • Fax: 305-662-2552
Mailing address:
  • Phone: 305-662-7702
  • Fax: 305-662-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN16503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: