=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811662596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEVEN BRIDGES DENTAL PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2021
-----------------------------------------------------
Last Update Date | 10/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2999 NE 191 ST SUITE 602
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-682-1795
-----------------------------------------------------
Fax | 305-847-3300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2999 NE 191 ST SUITE 602
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-682-1795
-----------------------------------------------------
Fax | 305-847-3300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MAILEN PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-682-1795
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------