Healthcare Provider Details

I. General information

NPI: 1497279327
Provider Name (Legal Business Name): CONTEMPORARY ORTHODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 SW 107TH AVE
MIAMI FL
33165-3640
US

IV. Provider business mailing address

500 BRICKELL AVE STE M-204
MIAMI FL
33131-2576
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-3737
  • Fax:
Mailing address:
  • Phone: 954-217-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDN14139
License Number StateFL

VIII. Authorized Official

Name: MARIA YAZJI
Title or Position: OWNER
Credential:
Phone: 954-217-3737