Healthcare Provider Details

I. General information

NPI: 1326478470
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF KENDALL DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 N KENDALL DR 207
MIAMI FL
33176-1029
US

IV. Provider business mailing address

11400 N KENDALL DR 207
MIAMI FL
33176-1029
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-2254
  • Fax:
Mailing address:
  • Phone: 305-271-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MIKE COLE
Title or Position: VP INSURANCE PLAN MANAGEMENT
Credential:
Phone: 727-726-1611