=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891337556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDDOS PEDIATRIC DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2019
-----------------------------------------------------
Last Update Date | 10/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8319 W FLAGLER ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-340-5521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8319 W FLAGLER ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-340-5521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST/OWNER
-----------------------------------------------------
Name | DR. TATIANA TOQUICA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 305-340-5521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------