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General NPI Number Information
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NPI Number | 1073113296
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CENTER OF GARDENS INC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 18244 NW 27TH AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-3501
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Country | US
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Telephone | 305-456-2680
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Fax |
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Provider Business Mailing Address
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Address Line | 2645 S DOUGLAS RD STE 703
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City | MIAMI
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State | FL
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Zip | 33133-2745
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Country | US
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Telephone | 954-513-9277
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENRIQUE ACOSTA
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Credential | DDS
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Telephone | 305-454-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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