Healthcare Provider Details

I. General information

NPI: 1518527159
Provider Name (Legal Business Name): SANITAS DENTAL OF SOUTH FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NW 87TH AVE STE 202
DORAL FL
33172-2656
US

IV. Provider business mailing address

2000 NW 87TH AVE STE 202
DORAL FL
33172-2656
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-6459
  • Fax: 786-431-5638
Mailing address:
  • Phone: 786-615-6459
  • Fax: 786-431-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: LUIS F BRETON
Title or Position: DENTIST/OWNER
Credential: D.M.D.
Phone: 786-615-6459