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General NPI Number Information
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NPI Number | 1447656491
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Entity Type | Organization
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Legal Business Name | TOTAL DENTAL CARE OF FLORIDA, LLC
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 4410 W 16TH AVE STE 30
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City | HIALEAH
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State | FL
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Zip | 33012-7835
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Country | US
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Telephone | 305-747-7711
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Fax | 305-697-9785
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Provider Business Mailing Address
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Address Line | PO BOX 440308
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City | MIAMI
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State | FL
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Zip | 33144-0308
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Country | US
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Telephone | 786-971-2319
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARID BLANCO
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Credential | DMD
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Telephone | 305-747-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN16115
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License Number State | FL
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