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General NPI Number Information
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NPI Number | 1972877215
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Entity Type | Organization
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Legal Business Name | FLORIDA CITY DENTAL
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 103 E LUCY ST # 125
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City | HOMESTEAD
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State | FL
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Zip | 33034-2501
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Country | US
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Telephone | 305-242-5777
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Fax | 305-242-5722
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Provider Business Mailing Address
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Address Line | 103 E LUCY ST # 125
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City | HOMESTEAD
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State | FL
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Zip | 33034-2501
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Country | US
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Telephone | 305-242-5777
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Fax | 305-242-5722
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Authorized Official
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Title or Position | OFFICER
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Name | MRS. CARLA MARTINEZ
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Credential |
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Telephone | 305-242-5777
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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 | DN14911
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License Number State | FL
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