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General NPI Number Information
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NPI Number | 1669743761
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Entity Type | Organization
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Legal Business Name | DENTAL ADVANTAGE ADMINISTRATION
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 3383 NW 7TH ST SUITE 101
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City | MIAMI
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State | FL
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Zip | 33125-4140
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Country | US
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Telephone | 305-642-0003
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Fax | 305-642-0009
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Provider Business Mailing Address
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Address Line | 3383 NW 7TH ST SUITE 101
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City | MIAMI
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State | FL
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Zip | 33125-4140
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Country | US
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Telephone | 305-642-0003
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Fax | 305-642-0009
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REYNA LACAYO
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Credential | ADMINISTRATION
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Telephone | 305-642-0003
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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 | 19356
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License Number State | FL
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