Healthcare Provider Details

I. General information

NPI: 1669156436
Provider Name (Legal Business Name): COSMETIC SMILES DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 NW 87TH CT STE 166
HIALEAH GARDENS FL
33018-4521
US

IV. Provider business mailing address

10101 E BAY HARBOR DR APT 309
BAY HARBOR ISLANDS FL
33154-1201
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-9322
  • Fax: 305-364-0983
Mailing address:
  • Phone: 786-916-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDORF MONTERO
Title or Position: MGR
Credential: DMD
Phone: 786-916-7616