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General NPI Number Information
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NPI Number | 1225247679
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Entity Type | Organization
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Legal Business Name | ROGER A. FINE, D.D.S., P.A.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 W 49TH ST SUITE 314
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City | HIALEAH
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State | FL
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Zip | 33012-2900
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Country | US
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Telephone | 305-558-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 W 49TH ST SUITE 314
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City | HIALEAH
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State | FL
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Zip | 33012-2900
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Country | US
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Telephone | 305-558-2321
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER ALAN FINE
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Credential | D.D.S.
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Telephone | 305-558-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN 5189
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License Number State | FL
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