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General NPI Number Information
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NPI Number | 1982814687
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Entity Type | Organization
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Legal Business Name | KENWARD AND MAYORAL DENTISTRY PARTNERSHIP
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 12651 S DIXIE HWY STE 400
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City | PINECREST
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State | FL
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Zip | 33156-5956
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Country | US
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Telephone | 305-255-7722
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Fax | 305-255-2152
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Provider Business Mailing Address
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Address Line | 12651 S DIXIE HWY STE 400
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City | PINECREST
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State | FL
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Zip | 33156-5956
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Country | US
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Telephone | 305-255-7722
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Fax | 305-255-2152
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Authorized Official
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Title or Position | OWNER
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Name | DR. OSVALDO MAYORAL
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Credential |
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Telephone | 305-255-7722
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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 | DN11644
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN8555
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License Number State | FL
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