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NPI Code Detail

MEDICARE: MIAMI GARDENS DENTAL,INC

MEDICARE: MIAMI GARDENS 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
1122300000XDentistDN17100FL
21223G0001XGeneral Practice DentistryDN17100FL

General Provider Information

NPI Number : 1558663906
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIAMI GARDENS DENTAL,INC
Provider Business Mailing Address
First Line : 4538 NW 183RD ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33055-3045
Country : US
Telephone Number : 305-625-8272
Fax Number :
Provider Business Practice Location Address
First Line : 4538 NW 183RD ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33055-3045
Country : US
Telephone Number : 305-625-8272
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LUISA Y CORRALES-IGLESIAS
Credential : D.D.S
Telephone Number : 305-625-8272
Provider Enumeration Date : 11/17/2010
Last Update Date : 11/17/2010

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1639226293 — DR. RONDA S SINGH O.D.
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1861546277 — MRS. LUISA YAMISEL CORRALES-IGLESIAS DDS
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4538 NW 183RD ST
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1407135890 — PRICE CHOICE PHARMACY 2
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Directions to “MIAMI GARDENS DENTAL,INC ” Practice Location

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