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General NPI Number Information
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NPI Number | 1487669826
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Entity Type | Organization
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Legal Business Name | DORAL DENTAL PARTNERS
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 10620 NW 19 ST DORAL DENTAL PARTNERS
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City | DORAL
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State | FL
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Zip | 33172
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Country | US
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Telephone | 786-331-7055
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Fax | 786-331-7455
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Provider Business Mailing Address
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Address Line | 10620 NW 19 ST
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City | DORAL
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State | FL
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Zip | 33172
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Country | US
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Telephone | 786-331-7055
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Fax | 786-331-7455
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MAGDA E COLON
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Credential |
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Telephone | 786-331-7055
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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 | DN0012295
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0011940
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License Number State | FL
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