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General NPI Number Information
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NPI Number | 1942848841
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Entity Type | Organization
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Legal Business Name | SPECIALIZED DENTISTRY OF MIAMI, PA
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 2020 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-2541
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Country | US
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Telephone | 917-279-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-2541
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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 | PRESIDENT
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Name | DR. ISMAEL EL KHOULY CASTILLA
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Credential | DDS, MS, PHD
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Telephone | 917-279-0899
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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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