Healthcare Provider Details

I. General information

NPI: 1033264858
Provider Name (Legal Business Name): HOLISTIC DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 NW 27TH AVE
MIAMI FL
33125-3041
US

IV. Provider business mailing address

477 NW 27TH AVE
MIAMI FL
33125-3041
US

V. Phone/Fax

Practice location:
  • Phone: 305-541-8884
  • Fax:
Mailing address:
  • Phone: 305-541-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PAGE L SCHREIBER
Title or Position: DUENO
Credential:
Phone: 305-541-8884