Healthcare Provider Details

I. General information

NPI: 1265869663
Provider Name (Legal Business Name): TOTAL DENTAL SPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15760 SW 56TH ST
MIAMI FL
33185
US

IV. Provider business mailing address

15760 SW 56TH ST
MIAMI FL
33185
US

V. Phone/Fax

Practice location:
  • Phone: 305-760-9449
  • Fax: 305-541-0333
Mailing address:
  • Phone: 305-760-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN16661
License Number StateFL

VIII. Authorized Official

Name: DR. ARIEL J BARREIRO
Title or Position: OWNER
Credential: D.D.S
Phone: 305-760-9449