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General NPI Number Information
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NPI Number | 1215374293
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Entity Type | Organization
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Legal Business Name | PANAMERICAN DENTAL CLINIC PA & ASSOCIATES
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 2060 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-2548
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Country | US
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Telephone | 305-444-4430
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Fax | 305-885-7767
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Provider Business Mailing Address
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Address Line | 2060 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-2548
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Country | US
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Telephone | 305-444-4430
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Fax | 305-885-7767
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MARLEN GUTIERREZ
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Credential | DDS
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Telephone | 305-855-7767
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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 | DN20998
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License Number State | FL
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