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General NPI Number Information
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NPI Number | 1932758505
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Entity Type | Individual
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Provider Name | MINA GHORBANIFARAJZADEH DMD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2019
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 757 W 41ST ST
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3413
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Country | US
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Telephone | 305-672-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 NE 210TH ST
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City | MIAMI
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State | FL
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Zip | 33179-1521
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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 |
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Name |
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Credential |
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Telephone |
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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 | 24114
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License Number State | FL
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