=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710275185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEST SMILE DENTAL CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2011
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1961 NE 196TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-3629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-251-5818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8000 BISCAYNE BLVD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-517-6127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARIA C VIDAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-251-5818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN16229
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------