Healthcare Provider Details

I. General information

NPI: 1396150199
Provider Name (Legal Business Name): GATEWAY DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W 68TH ST STE 115
HIALEAH FL
33014-4406
US

IV. Provider business mailing address

1800 W 68TH ST STE 115
HIALEAH FL
33014-4406
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-2300
  • Fax:
Mailing address:
  • Phone: 305-856-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN15212
License Number StateFL

VIII. Authorized Official

Name: DR. PABLO MIRANDA
Title or Position: OWNER
Credential: DMD
Phone: 305-856-2300