Healthcare Provider Details

I. General information

NPI: 1912598814
Provider Name (Legal Business Name): OH I DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 DAVIE RD STE A
DAVIE FL
33314-7121
US

IV. Provider business mailing address

5651 DAVIE RD STE A
DAVIE FL
33314-7121
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-9737
  • Fax:
Mailing address:
  • Phone: 954-587-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA MAGURNO
Title or Position: PROSTHODONTIST
Credential: DDS
Phone: 954-587-9737