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General NPI Number Information
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NPI Number | 1093733024
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Entity Type | Organization
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Legal Business Name | EDUARDO NORTHLAND,D.D.S.,P.A.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 2825 S.W. 22 STREET
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City | CORAL GABLES
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State | FL
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Zip | 33145-3203
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Country | US
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Telephone | 305-448-1172
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Fax | 305-446-2724
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Provider Business Mailing Address
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Address Line | 2825 S.W. 22 STREET
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City | CORAL GABLES
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State | FL
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Zip | 33145-3203
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Country | US
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Telephone | 305-448-1172
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Fax | 305-446-2724
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDUARDO NORTHLAND
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Credential |
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Telephone | 305-448-1172
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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 | DN0012377
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License Number State | FL
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