Healthcare Provider Details

I. General information

NPI: 1588581367
Provider Name (Legal Business Name): CORAL COAST DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

457 HIALEAH DR STE 3
HIALEAH FL
33010-5342
US

IV. Provider business mailing address

13552 SW 38TH LN
MIAMI FL
33175-3214
US

V. Phone/Fax

Practice location:
  • Phone: 305-422-9339
  • Fax: 305-850-6539
Mailing address:
  • Phone: 305-815-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE FELIX VELAZQUEZ
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 305-815-9509