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General NPI Number Information
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NPI Number | 1528573094
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Entity Type | Organization
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Legal Business Name | MIDTOWN DORAL FAMILY DENTISTRY AND ORTHODONTICS PA
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 7885 NW 107TH AVE STE 4-05
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City | DORAL
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State | FL
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Zip | 33178-4426
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Country | US
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Telephone | 954-817-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 7885 NW 107TH AVE STE 4-05
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City | DORAL
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State | FL
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Zip | 33178-4426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DMD
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Name | ANDREA TRUJILLO
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Credential |
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Telephone | 954-433-5231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN15532
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License Number State | FL
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