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General NPI Number Information
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NPI Number | 1003202375
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Entity Type | Organization
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Legal Business Name | RIO DENTAL GROUP INC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 279 NW 82ND AVE
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City | MIAMI
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State | FL
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Zip | 33126-8339
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Country | US
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Telephone | 786-518-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 279 NW 82ND AVE
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City | MIAMI
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State | FL
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Zip | 33126-8339
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Country | US
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Telephone | 786-518-2004
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Fax |
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Authorized Official
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Title or Position | VP
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Name | MR. JUAN GONZALEZ
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Credential |
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Telephone | 786-518-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN13222
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License Number State | FL
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