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General NPI Number Information
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NPI Number | 1063895662
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Entity Type | Organization
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Legal Business Name | WEST KENDALL DENTAL ASSOCIATES INC.
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 11880 SW 40TH ST SUITE 302
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City | MIAMI
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State | FL
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Zip | 33175-3584
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Country | US
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Telephone | 305-221-0102
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Fax | 305-221-0103
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Provider Business Mailing Address
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Address Line | 11880 SW 40TH ST SUITE 302
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City | MIAMI
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State | FL
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Zip | 33175-3584
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Country | US
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Telephone | 305-221-0102
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Fax | 305-221-0103
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALBA SURI
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Credential |
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Telephone | 305-221-0102
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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 | DN7615
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License Number State | FL
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