=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841385838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEL RIO & ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 04/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5975 SUNSET DR SUITE 404
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-668-4909
-----------------------------------------------------
Fax | 305-668-4989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5975 SUNSET DR SUITE 404
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-668-4909
-----------------------------------------------------
Fax | 305-668-4989
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | DR. GUILLERMO DEL RIO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 305-266-4071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN11796
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN0011244
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------