Healthcare Provider Details

I. General information

NPI: 1407719107
Provider Name (Legal Business Name): AF DELUXE SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8460 SW 8TH ST
MIAMI FL
33144-4153
US

IV. Provider business mailing address

19610 NW 41ST AVE
MIAMI GARDENS FL
33055-1862
US

V. Phone/Fax

Practice location:
  • Phone: 786-750-2478
  • Fax:
Mailing address:
  • Phone:
  • 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: FLAVIO FUENTES FALCON
Title or Position: DENTIST
Credential: DMD
Phone: 786-750-2478