Healthcare Provider Details

I. General information

NPI: 1669653754
Provider Name (Legal Business Name): SAMANTHA GELUDA-LEWIN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2007
Last Update Date: 11/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N MIAMI BEACH BLVD K-MART DENTAL OFFICE
NORTH MIAMI BEACH FL
33162-3716
US

IV. Provider business mailing address

900 N MIAMI BEACH BLVD K-MART DENTAL OFFICE
NORTH MIAMI BEACH FL
33162-3716
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-9001
  • Fax:
Mailing address:
  • Phone: 305-947-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 17805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: