Healthcare Provider Details

I. General information

NPI: 1053247304
Provider Name (Legal Business Name): GERALDINE PALACIOS CARRENO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5396 W 14TH AVE
HIALEAH FL
33012-3032
US

IV. Provider business mailing address

5396 W 14TH AVE
HIALEAH FL
33012-3032
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-9993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: