Healthcare Provider Details

I. General information

NPI: 1457263410
Provider Name (Legal Business Name): PEDIATRIC DENTAL CENTER OF LAUDERHILL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 N STATE ROAD 7
LAUDERHILL FL
33313-5007
US

IV. Provider business mailing address

1879 N STATE ROAD 7
LAUDERHILL FL
33313-5007
US

V. Phone/Fax

Practice location:
  • Phone: 305-454-0911
  • Fax:
Mailing address:
  • Phone:
  • 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: ENRIQUE ACOSTA ACOSTA
Title or Position: PRESIDENT
Credential: DDS
Phone: 954-513-9277