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General NPI Number Information
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NPI Number | 1629108238
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Entity Type | Organization
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Legal Business Name | MLV DENTAL MEDICAL MANAGEMENT CO. INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 995 N MIAMI BEACH BLVD SUITE # 100
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-3721
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Country | US
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Telephone | 305-948-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 10861 SW 156TH ST
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City | MIAMI
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State | FL
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Zip | 33157-1339
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Country | US
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Telephone | 305-948-0458
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LORNA SMITH
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Credential |
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Telephone | 305-300-7244
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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 | DN16812
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License Number State | FL
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