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General NPI Number Information
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NPI Number | 1588391502
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Entity Type | Organization
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Legal Business Name | FLORIDA DENTAL PROFESSIONALS, P.A.
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 7775 SW 87TH AVE STE 112
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City | MIAMI
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State | FL
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Zip | 33173-2536
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Country | US
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Telephone | 305-598-9072
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Fax |
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Provider Business Mailing Address
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Address Line | 7775 SW 87TH AVE STE 112
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City | MIAMI
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State | FL
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Zip | 33173-2536
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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 | CREDENTIALING COORDINATOR
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Name | COURTNEY MONTEITH
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Credential |
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Telephone | 217-540-8306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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