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General NPI Number Information
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NPI Number | 1487426482
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Entity Type | Organization
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Legal Business Name | PRIME PEDIATRIC DENTAL GROUP PA
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 13195 BISCAYNE BAY DR
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2204
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Country | US
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Telephone | 305-251-5390
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Fax | 305-675-3282
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Provider Business Mailing Address
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Address Line | 13195 BISCAYNE BAY DR
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2204
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Country | US
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Telephone | 305-251-5390
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Fax | 305-675-3282
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE MELLADO
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Credential | DMD
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Telephone | 305-321-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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