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General NPI Number Information
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NPI Number | 1245807601
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Entity Type | Organization
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Legal Business Name | DENTAL FITNESS INC
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 8555 NE 2ND AVE
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City | EL PORTAL
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State | FL
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Zip | 33138-3001
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Country | US
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Telephone | 305-758-5878
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Fax |
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Provider Business Mailing Address
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Address Line | 8555 NE 2ND AVE
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City | EL PORTAL
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State | FL
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Zip | 33138-3001
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Country | US
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Telephone | 305-758-5878
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MARIO GARCIA
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Credential | DDS
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Telephone | 786-306-0927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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