Healthcare Provider Details

I. General information

NPI: 1457875221
Provider Name (Legal Business Name): HECTOR L BIBILONIA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11423 NW 88TH AVE
HIALEAH FL
33018-1961
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 116
DORAL FL
33122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 786-461-0493
  • Fax:
Mailing address:
  • Phone: 305-591-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: