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General NPI Number Information
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NPI Number | 1184899866
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Entity Type | Organization
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Legal Business Name | COSMETIC DENTISTRY CORPORATION
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 12955 BISCAYNE BLVD SUITE 210
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2037
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Country | US
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Telephone | 305-892-0008
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Fax | 305-892-0018
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Provider Business Mailing Address
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Address Line | 12955 BISCAYNE BLVD SUITE 210
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2037
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Country | US
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Telephone | 305-892-0008
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Fax | 305-892-0018
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELENA KATZ
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Credential | DMD
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Telephone | 305-892-0008
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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 | DN15913
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License Number State | FL
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