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General NPI Number Information
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NPI Number | 1215518824
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CENTER OF RIVER LANDING
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1440 NW NORTH RIVER DR STE 345
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City | MIAMI
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State | FL
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Zip | 33125-2894
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Country | US
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Telephone | 786-368-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 NW NORTH RIVER DR STE 345
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City | MIAMI
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State | FL
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Zip | 33125-2894
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Country | US
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Telephone | 786-368-6212
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | ENRIQUE ACOSTA
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Credential | DDS
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Telephone | 786-353-9887
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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