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General NPI Number Information
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NPI Number | 1417183013
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Entity Type | Organization
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Legal Business Name | MIAMI BEACH DENTAL SPECIALTY CENTER LLC
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 900 71ST ST
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City | MIAMI BEACH
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State | FL
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Zip | 33141-2916
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Country | US
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Telephone | 305-761-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 900 71ST ST
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City | MIAMI BEACH
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State | FL
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Zip | 33141-2916
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Country | US
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Telephone | 305-761-1178
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JEFFREY H GORDON
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Credential | D.M.D.
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Telephone | 305-761-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0011082
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License Number State | FL
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