Healthcare Provider Details

I. General information

NPI: 1780890095
Provider Name (Legal Business Name): ERNESTO PAZ JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PONCE DE LEON BLVD
MIAMI FL
33135-1040
US

IV. Provider business mailing address

45 PONCE DE LEON BLVD
MIAMI FL
33135-1040
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-4433
  • Fax: 305-441-2821
Mailing address:
  • Phone: 305-448-4433
  • Fax: 305-441-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN16045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: