Healthcare Provider Details

I. General information

NPI: 1760964977
Provider Name (Legal Business Name): ORAL SURGERY & IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 SW 63RD AVE
SOUTH MIAMI FL
33143-4809
US

IV. Provider business mailing address

7231 SW 63RD AVE
SOUTH MIAMI FL
33143-4809
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-1191
  • Fax: 305-667-2712
Mailing address:
  • Phone: 305-667-1191
  • Fax: 305-667-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRED PEDROLETTI
Title or Position: OWNER
Credential: DMD
Phone: 305-667-1191