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General NPI Number Information
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NPI Number | 1962658583
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Entity Type | Organization
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Legal Business Name | AVENTURA ENDODONTIC GROUP, LLC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 19495 BISCAYNE BLVD SUITE #404
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City | AVENTURA
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State | FL
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Zip | 33180-2318
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Country | US
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Telephone | 305-933-0001
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Fax | 305-933-2122
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Provider Business Mailing Address
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Address Line | 19495 BISCAYNE BLVD. SUITE #404
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City | AVENTURA
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State | FL
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Zip | 33180
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Country | US
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Telephone | 305-933-0001
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Fax | 305-933-2122
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARTHUR J. LANE
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Credential | DDS
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Telephone | 305-933-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN16345
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4125
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License Number State | FL
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