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General NPI Number Information
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NPI Number | 1659770592
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Entity Type | Organization
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Legal Business Name | FRED PEDROLETTI DMD PA
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Dates
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Enumeration Date | 08/16/2014
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 7231 SW 63RD AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4809
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Country | US
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Telephone | 305-667-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 7231 SW 63RD AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4809
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Country | US
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Telephone | 305-667-1191
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. FRED PEDROLETTI
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Credential | DMD
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Telephone | 954-790-3130
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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 | DN17712
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License Number State | FL
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