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General NPI Number Information
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NPI Number | 1881805257
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CENTERS OF MIAMI
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2645 SW 37TH AVE SUITE 703
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City | MIAMI
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State | FL
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Zip | 33133-2754
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Country | US
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Telephone | 305-448-3228
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Fax | 305-447-8828
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Provider Business Mailing Address
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Address Line | 2645 SW 37TH AVE SUITE 703
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City | MIAMI
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State | FL
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Zip | 33133-2754
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Country | US
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Telephone | 305-448-3228
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Fax | 305-447-8828
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENRIQUE ACOSTA
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Credential | DDS
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Telephone | 305-448-3228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN17284
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License Number State | FL
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