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General NPI Number Information
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NPI Number | 1932538493
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Entity Type | Organization
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Legal Business Name | DEJESUS ORTHODONTIC TEAM LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 11445 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3311
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Country | US
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Telephone | 786-443-0442
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Fax |
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Provider Business Mailing Address
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Address Line | 11445 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3311
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Country | US
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Telephone | 786-443-0442
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. CHRISTIAN ELLIS DEJESUS
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Credential | D.M.D
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Telephone | 305-726-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN18028
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License Number State | FL
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