Healthcare Provider Details

I. General information

NPI: 1437873957
Provider Name (Legal Business Name): 4 KIDS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 W 49TH ST
HIALEAH FL
33012-3322
US

IV. Provider business mailing address

8020 LOS PINOS BLVD
CORAL GABLES FL
33143-6455
US

V. Phone/Fax

Practice location:
  • Phone: 954-394-0658
  • Fax:
Mailing address:
  • Phone: 954-394-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MURIEL IWANOWSKI
Title or Position: MANAGING PARTNER
Credential: DMD
Phone: 954-394-0658