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General NPI Number Information
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NPI Number | 1619461639
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Entity Type | Organization
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Legal Business Name | FACIAL SUBTLETIES
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 975 ARTHUR GODFREY RD STE 306
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3350
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Country | US
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Telephone | 305-532-1728
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Fax | 305-532-1729
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Provider Business Mailing Address
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Address Line | 975 ARTHUR GODFREY RD STE 306
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3350
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Country | US
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Telephone | 305-532-1728
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Fax | 305-532-1729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGELA MCMULLIN
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Credential | DMD
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Telephone | 609-915-9087
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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 | 21820
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN21820
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License Number State | FL
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