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General NPI Number Information
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NPI Number | 1417543588
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Entity Type | Organization
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Legal Business Name | MIAMI DENTAL COMMUNITY PA
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 12333 NW 18TH ST STE 4
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4386
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Country | US
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Telephone | 786-216-3294
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Fax |
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Provider Business Mailing Address
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Address Line | 12333 NW 18TH ST STE 4
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4386
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Country | US
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Telephone | 786-216-3294
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRISTIAN MOLINARES
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Credential |
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Telephone | 786-216-3294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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