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General NPI Number Information
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NPI Number | 1619407566
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Entity Type | Individual
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Provider Name | PATRICIA JORGE FORNES DMD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 7550 SW 57TH AVE STE 214
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5336
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Country | US
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Telephone | 305-667-9860
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Fax | 305-667-9861
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Provider Business Mailing Address
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Address Line | 7550 SW 57TH AVE STE 214
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5336
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Country | US
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Telephone | 305-667-9860
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Fax | 305-667-9861
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN22714
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License Number State | FL
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