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General NPI Number Information
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NPI Number | 1487029138
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Entity Type | Organization
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Legal Business Name | PARADISE DENTAL CARE INC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 4301 PALM AVE SUITE C
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 786-953-8210
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Fax | 786-953-8146
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Provider Business Mailing Address
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Address Line | 4301 PALM AVE SUITE C
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 786-953-8210
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Fax | 786-953-8146
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ODALYS VALENZUELA
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Credential | DDS
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Telephone | 786-953-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15755
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License Number State | FL
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