Healthcare Provider Details

I. General information

NPI: 1508112970
Provider Name (Legal Business Name): SENIOR DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NW 42ND AVE SUITE 504
MIAMI FL
33126-5683
US

IV. Provider business mailing address

351 NW 42ND AVE SUITE 504
MIAMI FL
33126-5683
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-3552
  • Fax:
Mailing address:
  • Phone: 305-642-3552
  • Fax:

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: DR. JUAN M GARCES
Title or Position: CEO
Credential: M.D.
Phone: 305-444-1244