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General NPI Number Information
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NPI Number | 1871682914
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Entity Type | Organization
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Legal Business Name | MLV DENTAL MEDICAL MANAGEMENT CO
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 995 NE 167ST. STE 100
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162
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Country | US
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Telephone | 305-948-0456
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Fax | 305-948-0458
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Provider Business Mailing Address
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Address Line | 995 NE 167ST. STE 100
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162
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Country | US
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Telephone | 305-948-0456
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Fax | 305-948-0458
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. HOPETON ADOLPH WRIGHT
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Credential |
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Telephone | 305-948-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | FL
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