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General NPI Number Information
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NPI Number | 1972492411
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Entity Type | Organization
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Legal Business Name | FUNDROA DENTAL SMILE LLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 8740 N KENDALL DR STE 220
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City | MIAMI
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State | FL
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Zip | 33176-2221
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Country | US
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Telephone | 305-270-8029
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Fax | 305-273-8437
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Provider Business Mailing Address
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Address Line | 8740 N KENDALL DR STE 220
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City | MIAMI
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State | FL
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Zip | 33176-2221
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Country | US
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Telephone | 305-270-8029
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JELSEY FUNDORA
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Credential |
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Telephone | 786-317-1337
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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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