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General NPI Number Information
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NPI Number | 1639850720
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Entity Type | Organization
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Legal Business Name | BLU DENTAL, LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 9715 NE 2ND AVE
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2310
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Country | US
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Telephone | 305-210-0258
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Fax |
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Provider Business Mailing Address
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Address Line | 7957 N UNIVERSITY DR # 138
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City | PARKLAND
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State | FL
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Zip | 33067-2601
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Country | US
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Telephone | 772-204-3529
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT RODRIGUEZ
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Credential | MBA
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Telephone | 772-204-3529
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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 |
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