Healthcare Provider Details

I. General information

NPI: 1528695442
Provider Name (Legal Business Name): ILA DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NE MIAMI GARDENS DR STE 215
NORTH MIAMI BEACH FL
33179-4844
US

IV. Provider business mailing address

1400 NE MIAMI GARDENS DR STE 215
NORTH MIAMI BEACH FL
33179-4844
US

V. Phone/Fax

Practice location:
  • Phone: 305-956-9996
  • Fax:
Mailing address:
  • Phone: 305-956-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAUDIA BARAKAT
Title or Position: DENTIST
Credential: DMD
Phone: 305-303-2158