=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932384229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AURA M PICON D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2008
-----------------------------------------------------
Last Update Date | 02/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13590 SW 134 AVE. SUITE 112
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-506-1300
-----------------------------------------------------
Fax | 305-506-1301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13590 SW 134TH AVE STE. 112
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN17825
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------