Healthcare Provider Details

I. General information

NPI: 1073720645
Provider Name (Legal Business Name): DENTAL GROUP OF SOUTH FLORIDA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13419 SW 56 ST
MIAMI FL
33175
US

IV. Provider business mailing address

13419 SW 56 ST
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-2663
  • Fax: 305-559-3040
Mailing address:
  • Phone: 305-559-2663
  • Fax: 305-559-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN11187
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN12021
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN16376
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH16946
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17638
License Number StateFL

VIII. Authorized Official

Name: MS. MARIA JOSEFINA ALVAREZ
Title or Position: PRESIDENT
Credential: DDS
Phone: 305-444-8591