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General NPI Number Information
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NPI Number | 1912318320
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF MIAMI PLLC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 9485 SW 72ND ST SUITE A240
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City | MIAMI
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State | FL
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Zip | 33173-3242
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Country | US
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Telephone | 786-360-5401
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Fax |
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Provider Business Mailing Address
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Address Line | 9485 SW 72 STREET SUITE A240
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City | MIAMI
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State | FL
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Zip | 33173
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Country | US
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Telephone | 786-360-5401
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEREK SANDERS
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Credential |
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Telephone | 305-598-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN17737
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN18428
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License Number State | FL
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