Healthcare Provider Details

I. General information

NPI: 1386509891
Provider Name (Legal Business Name): PERFECT SMILE AT DADELAND CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 SW 40TH ST STE A
MIAMI FL
33165-4065
US

IV. Provider business mailing address

9580 SW 40TH ST STE A
MIAMI FL
33165-4065
US

V. Phone/Fax

Practice location:
  • Phone: 786-631-3761
  • Fax:
Mailing address:
  • Phone: 786-631-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LIVEISYS PEDRAZA
Title or Position: OWNER
Credential: DDS
Phone: 786-337-1013