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NPI Code Detail

MEDICARE: INTERNATIONAL DENTAL, INC

MEDICARE: INTERNATIONAL DENTAL, INC
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
11223G0001XGeneral Practice DentistryDN20289FL

General Provider Information

NPI Number : 1497177182
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNATIONAL DENTAL, INC
Provider Business Mailing Address
First Line : 5376 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2165
Country : US
Telephone Number : 305-231-7477
Fax Number :
Provider Business Practice Location Address
First Line : 5376 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2165
Country : US
Telephone Number : 305-231-7477
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : RENATE E MANNS
Credential :
Telephone Number : 305-231-7477
Provider Enumeration Date : 01/14/2014
Last Update Date : 01/14/2014

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Directions to “INTERNATIONAL DENTAL, INC ” Practice Location

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