=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255543740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL COSMETICS OF FLORIDA, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 11/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9055 SW 87 AVENUE SUITE 300
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-595-5655
-----------------------------------------------------
Fax | 305-595-9011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9055 SW 87 AVENUE SUITE 300
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-595-5655
-----------------------------------------------------
Fax | 305-595-9011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTONIO OTERO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 305-595-5655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------