=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790239309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D & M DENTONURSE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2016
-----------------------------------------------------
Last Update Date | 08/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 441 SW 17TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-646-6868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 441 SW 17TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-646-6868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | ELIOVER FRANCISCO MILANES
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 305-646-6828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN18309
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------