Healthcare Provider Details

I. General information

NPI: 1144035999
Provider Name (Legal Business Name): A&R FAMILY DENTAL PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 NW 17TH ST UNIT 212
MIAMI FL
33182-1422
US

IV. Provider business mailing address

12750 NW 17TH ST UNIT 212
MIAMI FL
33182-1422
US

V. Phone/Fax

Practice location:
  • Phone: 786-542-5974
  • Fax:
Mailing address:
  • Phone: 786-542-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLENDA L ARRABAL
Title or Position: DOCTOR
Credential: DMD
Phone: 786-542-5974