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General NPI Number Information
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NPI Number | 1457990277
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Entity Type | Organization
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Legal Business Name | CANCER DENTAL SPECIALISTS, PA
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 8900 N KENDALL DRIVE MIAMI CANCER INSTITUTE
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City | MIAMI
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State | FL
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Zip | 33176
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Country | US
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Telephone | 786-527-7803
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 S DIXIE HWY UNIT 565664
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City | PINECREST
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State | FL
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Zip | 33256-7234
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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. EVAN ROSEN
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Credential | DMD
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Telephone | 305-742-7175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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