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General NPI Number Information
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NPI Number | 1912603598
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Entity Type | Organization
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Legal Business Name | KENDALL SQUARE DENTAL STUDIO PLLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 8905 SW 169TH CT STE 109
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City | MIAMI
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State | FL
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Zip | 33196-4770
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Country | US
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Telephone | 786-354-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 SW 144TH CT
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City | MIAMI
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State | FL
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Zip | 33184-3252
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Country | US
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Telephone | 786-354-1599
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JANS GANDUL CABRERA
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Credential | DMD
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Telephone | 786-354-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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