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General NPI Number Information
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NPI Number | 1851206205
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Entity Type | Organization
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Legal Business Name | HIALEAH DENTAL SPECIALTY GROUP
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 900 W 49TH ST STE 400
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City | HIALEAH
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State | FL
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Zip | 33012-3407
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Country | US
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Telephone | 305-558-1211
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Fax | 305-557-6360
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Provider Business Mailing Address
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Address Line | 900 W 49TH ST STE 400
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City | HIALEAH
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State | FL
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Zip | 33012-3407
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Country | US
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Telephone |
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Fax | 305-557-6360
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Authorized Official
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Title or Position | OWNER
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Name | JUAN CARLOS LAZO
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Credential | DDS
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Telephone | 305-558-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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