Healthcare Provider Details

I. General information

NPI: 1205949666
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF KENDALL DDS PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SW 87TH COURT #212
MIAMI FL
33176
US

IV. Provider business mailing address

9000 SW 87TH COURT #212
MIAMI FL
33176
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-2254
  • Fax:
Mailing address:
  • Phone: 305-271-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL COLE
Title or Position: VP INSURANCE PLAN MANAGEMENT
Credential:
Phone: 727-726-1611