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NPI Code Detail

MEDICARE: DENTAL ASSOCIATES OF BAL HARBOUR

MEDICARE: DENTAL ASSOCIATES OF BAL HARBOUR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/CenterDN0013451FL

General Provider Information

NPI Number : 1295977015
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL ASSOCIATES OF BAL HARBOUR
Provider Business Mailing Address
First Line : 10545 SW 74TH AVE
Second Line :
City : PINECREST
State : FL
Zip : 33156-3882
Country : US
Telephone Number : 786-512-3187
Fax Number : 305-740-9507
Provider Business Practice Location Address
First Line : 260 95TH ST
Second Line : SUITE 209
City : SURFSIDE
State : FL
Zip : 33154-2807
Country : US
Telephone Number : 305-866-8290
Fax Number : 305-866-8298
Authorized Official
Title or Position : DENTIST/OWNER
Name : ALFREDO DOMINGO CORPAS
Credential : DDS
Telephone Number : 786-512-3178
Provider Enumeration Date : 03/25/2009
Last Update Date : 03/25/2009

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Directions to “DENTAL ASSOCIATES OF BAL HARBOUR ” Practice Location

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