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General NPI Number Information
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NPI Number | 1871990069
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Entity Type | Organization
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Legal Business Name | AESTHETIC DENTISTRY OF SOUTH MIAMI
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 7600 SW 57TH AVE SUITE 116
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-667-7543
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 SW 57TH AVE SUITE 116
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-667-7543
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN CARLOS ERRO
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Credential | D.D.S
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Telephone | 305-667-7543
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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 | DN9599
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License Number State | FL
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