Healthcare Provider Details

I. General information

NPI: 1942557467
Provider Name (Legal Business Name): YOSVANY VARONA DEL PINO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE STE 2005
MIAMI FL
33136-1003
US

IV. Provider business mailing address

324 SW 62ND CT
MIAMI FL
33144-3136
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-6725
  • Fax:
Mailing address:
  • Phone: 786-317-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDRP1095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: