Healthcare Provider Details

I. General information

NPI: 1821462029
Provider Name (Legal Business Name): SYLVIA SANTANA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 NW 87TH CT STE 166
HIALEAH FL
33018-4521
US

IV. Provider business mailing address

11300 NW 87TH CT STE 166
HIALEAH FL
33018-4521
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-9322
  • Fax: 305-364-0983
Mailing address:
  • Phone: 305-364-9322
  • Fax: 305-364-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN19864
License Number StateFL

VIII. Authorized Official

Name: MRS. SYLVIA SANTANA
Title or Position: PRESIDENT
Credential: DMD
Phone: 305-364-9322