Healthcare Provider Details

I. General information

NPI: 1164143681
Provider Name (Legal Business Name): R M DENTAL OF PEMBROKE PINES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NW 179TH AVE STE 101
PEMBROKE PINES FL
33029-2819
US

IV. Provider business mailing address

15280 SW 49TH ST
MIRAMAR FL
33027-3643
US

V. Phone/Fax

Practice location:
  • Phone: 954-450-1303
  • Fax:
Mailing address:
  • Phone: 787-410-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CARISSA RAMOS CRUZ
Title or Position: DENTIST
Credential: DMD
Phone: 787-410-0625