=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417366493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT DENTAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2014
-----------------------------------------------------
Last Update Date | 08/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16125 NE 18TH AVE
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-4749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-949-2766
-----------------------------------------------------
Fax | 305-949-4118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16125 NE 18TH AVE
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-4749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-949-2766
-----------------------------------------------------
Fax | 305-949-4118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | EDWIN PIERRE SMITH
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 305-949-2766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN20102
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------