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General NPI Number Information
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NPI Number | 1114502572
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Entity Type | Organization
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Legal Business Name | RADIAS DENTAL AND AESTHETICS OF MIAMI, PA
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 12683 W SUNRISE BLVD
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City | SUNRISE
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State | FL
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Zip | 33323-0907
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Country | US
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Telephone | 945-846-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 12683 W SUNRISE BLVD
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City | SUNRISE
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State | FL
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Zip | 33323-0907
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Country | US
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Telephone | 945-846-2222
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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. RAUL DAVID MOLINA
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Credential | DMD
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Telephone | 954-846-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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