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General NPI Number Information
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NPI Number | 1790228856
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Entity Type | Organization
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Legal Business Name | FLASH SMILE LLC
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 3650 NW 82ND AVE STE 502
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City | DORAL
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State | FL
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Zip | 33166-6695
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Country | US
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Telephone | 786-312-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 240 NW 119TH AVE
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City | MIAMI
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State | FL
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Zip | 33182-1330
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Country | US
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Telephone | 786-312-4481
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAVIER PRIETO
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Credential | DDS
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Telephone | 786-312-4481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN22173
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License Number State | FL
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