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General NPI Number Information
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NPI Number | 1487462362
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Entity Type | Organization
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Legal Business Name | MIA DENTAL CORP
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 407 LINCOLN RD STE 700
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3024
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Country | US
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Telephone | 305-532-6795
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Fax | 305-728-0854
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Provider Business Mailing Address
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Address Line | 9451 SW 192ND DR
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City | CUTLER BAY
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State | FL
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Zip | 33157-7933
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Country | US
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Telephone | 786-970-9723
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SANDOR JAVIER VALLS
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Credential | DMD
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Telephone | 305-532-6795
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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 |
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License Number State |
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