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General NPI Number Information
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NPI Number | 1881764173
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Entity Type | Organization
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Legal Business Name | DORAL DENTAL
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 10818 NW 58TH ST
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City | DORAL
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State | FL
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Zip | 33178-2854
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Country | US
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Telephone | 305-477-7601
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Fax | 305-471-0137
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Provider Business Mailing Address
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Address Line | 10818 NW 58TH ST
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City | DORAL
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State | FL
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Zip | 33178-2854
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Country | US
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Telephone | 305-477-7601
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Fax | 305-471-0137
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Authorized Official
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Title or Position | DENTIST AND OWNER
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Name | DR. KERRY DAVID SMITH
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Credential | D.M.D
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Telephone | 305-477-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13223
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN14811
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 14900
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN11702
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License Number State | FL
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