Healthcare Provider Details

I. General information

NPI: 1740199454
Provider Name (Legal Business Name): IGLESIAS ORTHO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 SW 8TH ST STE 201
MIAMI FL
33135-3028
US

IV. Provider business mailing address

5901 SW 50TH TER
MIAMI FL
33155-6315
US

V. Phone/Fax

Practice location:
  • Phone: 305-428-2878
  • Fax: 305-428-2316
Mailing address:
  • Phone: 305-303-7596
  • Fax: 305-428-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CASSANDRA IGLESIAS
Title or Position: ORTHODONTIST
Credential: D.M.D., M.S.
Phone: 305-303-7596