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General NPI Number Information
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NPI Number | 1609387133
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Entity Type | Organization
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Legal Business Name | LATIN QUARTER DENTAL PA
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 1660 SW 1 ST
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City | MIAMI
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State | FL
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Zip | 33135
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Country | US
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Telephone | 305-642-8499
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 SW 1ST ST
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City | MIAMI
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State | FL
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Zip | 33135-2105
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Country | US
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Telephone | 305-642-8499
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | RODOLFO LEA PLAZA
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Credential | DDS
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Telephone | 305-642-8499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | FL
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