Healthcare Provider Details

I. General information

NPI: 1831529064
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: 08/01/2014
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

13195 SW 134TH ST 2ND FLOOR
MIAMI FL
33186-4461
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-2254
  • Fax: 305-271-0279
Mailing address:
  • Phone: 305-274-2499
  • Fax: 305-274-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE GOMEZ
Title or Position: PROVIDER RELATIONS
Credential:
Phone: 305-274-2499