=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821514159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAREK DUL DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2017
-----------------------------------------------------
Last Update Date | 02/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 NW 27TH AVE STE D
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33147-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-318-2337
-----------------------------------------------------
Fax | 786-513-8217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 NW 27TH AVE STE E-12
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33147-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-318-2337
-----------------------------------------------------
Fax | 786-513-8217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN22689
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------