Healthcare Provider Details

I. General information

NPI: 1477666139
Provider Name (Legal Business Name): KENNETH RAMON IRIGOYEN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 N KENDALL DR SUITE 409
MIAMI FL
33156-7706
US

IV. Provider business mailing address

5656 S.W.75 AVENUE
MIAMI FL
33143
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-4442
  • Fax: 305-670-7711
Mailing address:
  • Phone: 305-984-3240
  • Fax: 305-670-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN012003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: