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General NPI Number Information
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NPI Number | 1124120241
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Entity Type | Organization
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Legal Business Name | FLORIDIAN DENTAL CARE
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7900 NW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33147-4902
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Country | US
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Telephone | 305-693-8888
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Fax | 305-693-8893
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Provider Business Mailing Address
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Address Line | 158 W 12TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-3991
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Country | US
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Telephone | 305-887-7179
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Fax | 305-887-7179
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RICARDO ANTONIO EGUSQUIZA
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Credential | DDS
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Telephone | 305-693-8888
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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 | FL
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