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General NPI Number Information
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NPI Number | 1255941456
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Entity Type | Individual
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Provider Name | CARLOS JHONLE ACOSTA MARTIN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 820 E 41ST ST STE 202
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City | HIALEAH
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State | FL
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Zip | 33013-2463
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Country | US
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Telephone | 305-836-3635
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Fax |
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Provider Business Mailing Address
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Address Line | 8050 SW 72ND AVE APT 2703
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City | MIAMI
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State | FL
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Zip | 33143-7738
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Country | US
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Telephone | 786-372-1687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 25217
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License Number State | FL
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