Healthcare Provider Details

I. General information

NPI: 1538463443
Provider Name (Legal Business Name): ACADIA FAMILY DENTAL, ORTHODONTIC, AND IMPLANT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19517 NW 57TH AVE
MIAMI GARDENS FL
33055-4709
US

IV. Provider business mailing address

19517 NW 57TH AVE
MIAMI GARDENS FL
33055-4709
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-3111
  • Fax:
Mailing address:
  • Phone: 305-621-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS SOLOMON SEVEL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 305-621-3111