Healthcare Provider Details

I. General information

NPI: 1972854149
Provider Name (Legal Business Name): FLORIDA CHILDREN'S DENTISTRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE #52
HIALEAH FL
33012-7100
US

IV. Provider business mailing address

4410 W 16TH AVE STE 47
HIALEAH FL
33012-7193
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-9899
  • Fax:
Mailing address:
  • Phone: 305-825-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HOWARD FETNER
Title or Position: OWNER
Credential: D.M.D
Phone: 305-825-9899