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General NPI Number Information
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NPI Number | 1134859937
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Entity Type | Organization
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Legal Business Name | GEMA MEMORIAL DENTAL
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1165 W 49TH ST STE 203
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City | HIALEAH
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State | FL
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Zip | 33012-3372
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Country | US
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Telephone | 305-362-0010
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Fax | 789-808-4805
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Provider Business Mailing Address
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Address Line | 1165 W 49TH ST STE 203
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City | HIALEAH
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State | FL
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Zip | 33012-3372
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Country | US
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Telephone | 305-362-0010
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Fax | 789-808-4805
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MRS. DIANA ROMMEY DE QUESADA
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Credential | DMD
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Telephone | 305-362-0010
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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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