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General NPI Number Information
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NPI Number | 1437510211
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Entity Type | Organization
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Legal Business Name | SOFIA FONTECILLA DDS PA
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 3220 S DIXIE HWY #101
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City | MIAMI
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State | FL
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Zip | 33133-3609
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Country | US
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Telephone | 786-353-0735
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 S DIXIE HWY #101
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City | MIAMI
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State | FL
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Zip | 33133-3609
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Country | US
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Telephone | 786-353-0735
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SOFIA FONTECILLA
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Credential | DDS
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Telephone | 786-353-0735
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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 | 20387
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License Number State | FL
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