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General NPI Number Information
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NPI Number | 1467782839
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Entity Type | Organization
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Legal Business Name | MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF LONDON SQUARE, PA
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 13400 SW 134TH AVE SUITE 310
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City | MIAMI
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State | FL
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Zip | 33186-4523
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Country | US
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Telephone | 305-255-3986
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Fax | 305-255-9541
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Provider Business Mailing Address
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Address Line | 13195 SW 134TH ST FL 2
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City | MIAMI
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State | FL
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Zip | 33186-4461
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Country | US
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Telephone | 305-274-2499
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MELVYN GOBER
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Credential | DDS
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Telephone | 305-274-2499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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