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General NPI Number Information
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NPI Number | 1912357906
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Entity Type | Organization
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Legal Business Name | MJ DENTAL OFFICE
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 2360 W 68TH ST SUITE 124
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City | HIALEAH
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State | FL
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Zip | 33016-5514
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Country | US
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Telephone | 305-825-7447
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Fax | 786-534-9399
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Provider Business Mailing Address
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Address Line | 2360 W 68TH ST SUITE 124
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City | HIALEAH
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State | FL
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Zip | 33016-5514
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Country | US
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Telephone | 305-825-7447
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Fax | 786-534-9399
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Authorized Official
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Title or Position | OWNER
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Name | EDUARDO F GIL ARAUJO
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Credential |
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Telephone | 305-825-7447
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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 | DN20900
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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 | DN21842
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH24260
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH23064
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19789
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License Number State | FL
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