Healthcare Provider Details

I. General information

NPI: 1245807601
Provider Name (Legal Business Name): DENTAL FITNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 NE 2ND AVE
EL PORTAL FL
33138-3001
US

IV. Provider business mailing address

8555 NE 2ND AVE
EL PORTAL FL
33138-3001
US

V. Phone/Fax

Practice location:
  • Phone: 305-758-5878
  • Fax:
Mailing address:
  • Phone: 305-758-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIO GARCIA
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 786-306-0927