=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366730384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARIM ROSSINA REVOREDO DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2011
-----------------------------------------------------
Last Update Date | 06/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1878 SW 57TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-262-9299
-----------------------------------------------------
Fax | 305-262-8772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 ASTURIA AVE
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-4735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-238-7359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN20428
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------