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General NPI Number Information
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NPI Number | 1568613966
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Entity Type | Organization
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Legal Business Name | A O D DENTAL CLINIC
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 11865 SW 26TH ST STE G10
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City | MIAMI
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State | FL
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Zip | 33175-2471
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Country | US
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Telephone | 305-222-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 S BAYSHORE DR APT 4F
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City | MIAMI
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State | FL
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Zip | 33133-6001
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Country | US
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Telephone | 305-476-0230
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABEL O DE ANNA
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Credential | D.M.D.
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Telephone | 305-222-1150
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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 | 7784
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License Number State | FL
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