Healthcare Provider Details

I. General information

NPI: 1306462213
Provider Name (Legal Business Name): MIAMI HEALTHY SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8861 SW 69TH CT
PINECREST FL
33156-1605
US

IV. Provider business mailing address

8861 SW 69TH CT
PINECREST FL
33156-1605
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-2216
  • Fax: 305-663-6647
Mailing address:
  • Phone: 305-662-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACKIE PAZMINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-662-2216