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General NPI Number Information
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NPI Number | 1568190247
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Entity Type | Organization
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Legal Business Name | NUTRIDENTIST
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 311 NE 8TH ST STE 107
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City | HOMESTEAD
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State | FL
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Zip | 33030-4734
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Country | US
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Telephone | 305-245-3144
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Fax |
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Provider Business Mailing Address
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Address Line | 9453 SW 174TH ST
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5614
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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 | DENTIST
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Name | LAURA PEREZ MOREJON
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Credential | DMD
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Telephone | 786-298-4612
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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 |
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License Number State |
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