Healthcare Provider Details

I. General information

NPI: 1598651168
Provider Name (Legal Business Name): MAQ SMILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 WATERFORD DISTRICT DR STE 15
MIAMI FL
33126-2370
US

IV. Provider business mailing address

5600 WATERFORD DISTRICT DR STE 15
MIAMI FL
33126-2370
US

V. Phone/Fax

Practice location:
  • Phone: 786-876-5600
  • Fax: 786-687-5601
Mailing address:
  • Phone: 786-876-5600
  • Fax: 786-687-5601

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: YAMEL MAQUEIRA
Title or Position: OWNER
Credential: DDS
Phone: 407-978-9452