Healthcare Provider Details

I. General information

NPI: 1013418318
Provider Name (Legal Business Name): CARING DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 NW 12TH AVE
MIAMI FL
33128-1008
US

IV. Provider business mailing address

4789 SW 148TH AVE STE 205
DAVIE FL
33330-2121
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-1771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11339
License Number StateFL

VIII. Authorized Official

Name: DR. ROGER PHANORD
Title or Position: OWNER
Credential:
Phone: 305-685-7863