Healthcare Provider Details

I. General information

NPI: 1215518824
Provider Name (Legal Business Name): PEDIATRIC DENTAL CENTER OF RIVER LANDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 06/04/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 NW NORTH RIVER DR STE 345
MIAMI FL
33125-2894
US

IV. Provider business mailing address

1440 NW NORTH RIVER DR STE 345
MIAMI FL
33125-2894
US

V. Phone/Fax

Practice location:
  • Phone: 786-368-6212
  • Fax:
Mailing address:
  • Phone: 786-368-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ENRIQUE ACOSTA
Title or Position: PRESIDENT OWNER
Credential: DDS
Phone: 786-353-9887