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General NPI Number Information
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NPI Number | 1053666065
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Entity Type | Individual
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Provider Name | ALEXANDRA L BOTERO DDS
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 7902 NW 36TH ST STE 209
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City | DORAL
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State | FL
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Zip | 33166-6663
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Country | US
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Telephone | 305-402-4452
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Fax |
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Provider Business Mailing Address
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Address Line | 13936 SW 102ND CT
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City | MIAMI
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State | FL
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Zip | 33176-6611
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Country | US
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Telephone | 305-283-7772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D20575
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License Number State | FL
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