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General NPI Number Information
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NPI Number | 1225844269
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Entity Type | Organization
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Legal Business Name | LDT DENTAL LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 168 SE 1ST ST STE 1B
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City | MIAMI
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State | FL
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Zip | 33131-1403
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Country | US
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Telephone | 305-372-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 DAYTONIA RD
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City | MIAMI BEACH
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State | FL
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Zip | 33141-1732
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Country | US
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Telephone | 561-212-6362
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Fax |
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Authorized Official
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Title or Position | OWNER/GENERAL DENTIST
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Name | LAUREN TUCKMAN
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Credential | DMD
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Telephone | 561-212-6362
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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 |
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License Number State |
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