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General NPI Number Information
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NPI Number | 1396150199
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Entity Type | Organization
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Legal Business Name | GATEWAY DENTAL INC
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 6720 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7544
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Country | US
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Telephone | 954-541-9796
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Fax | 954-541-9795
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Provider Business Mailing Address
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Address Line | 6720 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7544
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Country | US
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Telephone | 954-541-9796
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Fax | 954-541-9795
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Authorized Official
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Title or Position | OWNER
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Name | DR. PABLO MIRANDA
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Credential | DMD
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Telephone | 305-856-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN15212
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License Number State | FL
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