=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326212945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLOBAL DENTAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2008
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 WESTWARD DR SUITE A
-----------------------------------------------------
City | MIAMI SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-885-1357
-----------------------------------------------------
Fax | 305-805-1899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 WESTWARD DR SUITE A
-----------------------------------------------------
City | MIAMI SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-885-1357
-----------------------------------------------------
Fax | 305-805-1899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. MARIA ANTONIA MAURI DE PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-885-1357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------