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General NPI Number Information
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NPI Number | 1477085983
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP OF SOUTH FLORIDA IV
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 11373 SW 211TH ST STE 10-11
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City | MIAMI
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State | FL
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Zip | 33189-2245
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Country | US
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Telephone | 305-542-3197
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Fax | 786-713-0959
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Provider Business Mailing Address
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Address Line | 11373 SW 211TH ST STE 10-11
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City | MIAMI
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State | FL
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Zip | 33189-2245
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Country | US
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Telephone | 305-542-3197
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Fax | 786-713-0959
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Authorized Official
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Title or Position | VP
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Name | ROLANDO BELLO
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Credential |
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Telephone | 305-542-3197
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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 | DN17638
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License Number State | FL
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