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General NPI Number Information
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NPI Number | 1336551134
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Entity Type | Organization
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Legal Business Name | MIAMI CENTER FOR ORTHODONTICS L.L.C
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 14660 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33175-8065
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Country | US
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Telephone | 305-223-0110
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Fax | 305-225-0065
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Provider Business Mailing Address
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Address Line | 14660 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33175-8065
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Country | US
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Telephone | 305-223-0110
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Fax | 305-225-0065
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ENRIQUE JOSE GALLO
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Credential | D.D.S
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Telephone | 305-223-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN 15973
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License Number State | FL
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