Healthcare Provider Details

I. General information

NPI: 1417860966
Provider Name (Legal Business Name): NOBOA DENTAL LLC/ DBA NORTHSIDE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 NW 27TH AVE STE E238
MIAMI FL
33147-4936
US

IV. Provider business mailing address

7900 NW 27TH AVE STE E238
MIAMI FL
33147-4936
US

V. Phone/Fax

Practice location:
  • Phone: 786-588-4740
  • Fax: 305-876-3194
Mailing address:
  • Phone: 786-588-4740
  • Fax: 305-876-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TERESA NOBOA
Title or Position: OWNER
Credential: DDS
Phone: 786-558-4740