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General NPI Number Information
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NPI Number | 1457736688
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Entity Type | Organization
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Legal Business Name | DENTAL G
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 2627 NE 203RD ST SUITE 220
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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 | 305-931-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 NE 203RD ST SUITE # 220
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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 | 305-931-1987
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Fax | 305-936-9403
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. MARIANA GITRON-BEER
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Credential | DMD
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Telephone | 305-931-1987
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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 | DN 18468
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License Number State | FL
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