Healthcare Provider Details

I. General information

NPI: 1609790674
Provider Name (Legal Business Name): ELEVATE DENTAL STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HIALEAH GARDENS BLVD
HIALEAH FL
33018-4322
US

IV. Provider business mailing address

7000 HIALEAH GARDENS BLVD
HIALEAH FL
33018-4322
US

V. Phone/Fax

Practice location:
  • Phone: 305-723-9203
  • Fax: 305-709-4939
Mailing address:
  • Phone: 305-723-9203
  • Fax: 305-709-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. DORIS LYDIA GUTIERREZ
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 786-792-7004