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General NPI Number Information
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NPI Number | 1932585296
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Entity Type | Organization
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Legal Business Name | LATITUDE DENTAL
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Dates
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Enumeration Date | 08/09/2015
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Last Update Date | 08/09/2015
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Provider Practice Location Address
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Address Line | 3650 NW 82ND AVE SUITE 402
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City | DORAL
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State | FL
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Zip | 33166-6658
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Country | US
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Telephone | 787-237-6813
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 NW 82ND AVE SUITE 402
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City | DORAL
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State | FL
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Zip | 33166-6658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. YARELIE CRUZ
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Credential | D.M.D
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Telephone | 787-237-6813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN20061
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License Number State | FL
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