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General NPI Number Information
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NPI Number | 1558818625
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP OF HIALEAH
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 3750 W 16 AVE STE 142-AU
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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 | 305-456-5722
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 W 16 AVE STE 142-AU
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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 | 305-456-5722
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DANILO A PEREZ
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Credential |
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Telephone | 305-456-5722
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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 | DN20258
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License Number State | FL
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