Healthcare Provider Details

I. General information

NPI: 1619802295
Provider Name (Legal Business Name): SAOLA LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 SW 40TH ST
MIAMI FL
33165-3993
US

IV. Provider business mailing address

711 SWAN AVE
MIAMI SPRINGS FL
33166-4327
US

V. Phone/Fax

Practice location:
  • Phone: 786-560-7567
  • Fax:
Mailing address:
  • Phone: 786-370-6827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: