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General NPI Number Information
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NPI Number | 1861783623
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Entity Type | Organization
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Legal Business Name | NEW ERA DENTAL, P.A
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 2011 W 62ND ST
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City | HIALEAH
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State | FL
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Zip | 33016-2657
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Country | US
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Telephone | 786-558-8637
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Fax | 786-558-8638
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Provider Business Mailing Address
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Address Line | 2011 W 62ND STREET
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City | HIALEAH
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State | FL
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Zip | 33016-2657
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Country | US
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Telephone | 786-558-8637
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Fax | 786-558-8638
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. BLANCA SANTOS
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Credential |
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Telephone | 786-558-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 621210B88
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License Number State | FL
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