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General NPI Number Information
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NPI Number | 1477819571
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Entity Type | Organization
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Legal Business Name | ORAL & FACIAL SURGERY OF MIAMI, LLC
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 3860 SW 8TH STREET SUITE 201
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-552-1193
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Fax | 305-443-0008
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Provider Business Mailing Address
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Address Line | 3860 SW 8TH STREET SUITE 201
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-552-1193
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Fax | 305-443-0008
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Authorized Official
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Title or Position | MANAGER
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Name | JOHANNY CACERES
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Credential | DDS
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Telephone | 786-271-3341
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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 | DN18755
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License Number State | FL
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