Healthcare Provider Details

I. General information

NPI: 1922834720
Provider Name (Legal Business Name): OASIS DENTAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 4 TH AVE SUITE 105A-106
HIALEAH FL
33010
US

IV. Provider business mailing address

2800 W 4 TH AVE SUITE 105A-106
HIALEAH FL
33010
US

V. Phone/Fax

Practice location:
  • Phone: 786-515-4830
  • Fax:
Mailing address:
  • Phone: 786-515-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROSALYN SUAREZ - ROSA
Title or Position: OWNER
Credential: D.D.S
Phone: 786-515-4830