Healthcare Provider Details

I. General information

NPI: 1679775803
Provider Name (Legal Business Name): JAYME ALENCAR DE OLIVEIRA FILHO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE ACC EAST 2ND FLOOR - DENTAL CLINIC
MIAMI FL
33136-1005
US

IV. Provider business mailing address

7725 SW 86TH ST APT#223
MIAMI FL
33143-7250
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6857
  • Fax:
Mailing address:
  • Phone: 305-409-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDTP483
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDTP483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: