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General NPI Number Information
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NPI Number | 1427272947
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Entity Type | Organization
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Legal Business Name | SUPER DENTAL INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 995 N MIAMI BEACH BLVD SUITE137
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-3721
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Country | US
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Telephone | 305-945-9333
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Fax | 305-945-9444
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Provider Business Mailing Address
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Address Line | 995 N MIAMI BEACH BLVD SUITE137
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-3721
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Country | US
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Telephone | 305-945-9333
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Fax | 305-945-9444
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | FRANK HIDALGO
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Credential |
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Telephone | 305-945-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 584600-2
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License Number State | FL
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