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General NPI Number Information
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NPI Number | 1083251920
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Entity Type | Organization
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Legal Business Name | SONRISAS DENTAL CLINIC INC
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 16875 NE 15TH AVE
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2914
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Country | US
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Telephone | 305-206-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 16875 NE 15TH AVE
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2914
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Country | US
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Telephone | 305-944-0000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. VIVIANA WAICH
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Credential | DDM
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Telephone | 305-944-0000
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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 |
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License Number State |
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