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General NPI Number Information
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NPI Number | 1437594330
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Entity Type | Organization
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Legal Business Name | AVENTURA CENTER FOR DENTAL SLEEP MEDICINE, INC
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 2627 NE 203RD ST SUITE 212
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City | AVENTURA
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State | FL
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Zip | 33180-1900
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Country | US
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Telephone | 305-932-9202
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Fax | 305-932-8448
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Provider Business Mailing Address
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Address Line | 1948 N OAK HAVEN CIR
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City | MIAMI
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State | FL
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Zip | 33179-2844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY DENNIS FREEDLINE
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Credential | DDS
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Telephone | 305-932-9202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 9103
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License Number State | FL
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