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General NPI Number Information
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NPI Number | 1780680421
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Entity Type | Organization
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Legal Business Name | PHOENIX DENTAL, INC
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2645 SW 37TH AVE STE 303
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City | MIAMI
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State | FL
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Zip | 33133-2754
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Country | US
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Telephone | 305-441-0499
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Fax | 305-441-0114
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Provider Business Mailing Address
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Address Line | 2645 SW 37TH AVE SUITE 303
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City | MIAMI
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State | FL
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Zip | 33133-2754
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Country | US
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Telephone | 305-441-0499
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Fax | 305-441-0114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMON BANA
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Credential | D.D,S.
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Telephone | 305-644-9375
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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 | DN13031
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License Number State | FL
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