=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376946145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELLENCE IN DENTAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2014
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3706 W 12TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-557-6661
-----------------------------------------------------
Fax | 305-557-9704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3706 W 12TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-557-6661
-----------------------------------------------------
Fax | 305-557-9704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. ROSA A ALVAREZ
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 305-557-6661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 17118
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------