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General NPI Number Information
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NPI Number | 1437873957
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Entity Type | Organization
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Legal Business Name | 4 KIDS DENTAL LLC
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 1096 W 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3322
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Country | US
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Telephone | 954-394-0658
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Fax |
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Provider Business Mailing Address
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Address Line | 8020 LOS PINOS BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33143-6455
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Country | US
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Telephone | 954-394-0658
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MURIEL IWANOWSKI
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Credential | DMD
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Telephone | 954-394-0658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics 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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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