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General NPI Number Information
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NPI Number | 1679960231
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Entity Type | Organization
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Legal Business Name | ROADS DENTAL SPECIALTY GROUP
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 1378 CORAL WAY 5TH FLOOR
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City | MIAMI
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State | FL
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Zip | 33145-2943
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Country | US
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Telephone | 305-856-1134
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Fax | 305-239-9452
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Provider Business Mailing Address
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Address Line | 1378 CORAL WAY 5TH FLOOR
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City | MIAMI
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State | FL
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Zip | 33145-2943
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Country | US
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Telephone | 305-856-1134
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Fax | 305-239-9452
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA C EAGAN
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Credential | DDS
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Telephone | 305-856-1134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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