Healthcare Provider Details

I. General information

NPI: 1851206205
Provider Name (Legal Business Name): HIALEAH DENTAL SPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST STE 400
HIALEAH FL
33012-3407
US

IV. Provider business mailing address

900 W 49TH ST STE 400
HIALEAH FL
33012-3407
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-1211
  • Fax: 305-557-6360
Mailing address:
  • Phone:
  • Fax: 305-557-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: JUAN CARLOS LAZO
Title or Position: OWNER
Credential: DDS
Phone: 305-558-1211