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General NPI Number Information
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NPI Number | 1467260349
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Entity Type | Organization
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Legal Business Name | AESTHETIC DENTAL PA
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 15436 NW 77TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5822
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Country | US
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Telephone | 305-557-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 9451 SW 192ND DR
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City | CUTLER BAY
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State | FL
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Zip | 33157-7933
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Country | US
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Telephone | 786-970-9723
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | SANDOR JAVIER VALLS
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Credential | DMD
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Telephone | 305-557-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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