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Provider Information for 1558690974

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1558690974

Calendar   Last Updated:  2009-12-14
  Certification Date: 


Name Value
NPI 1558690974
Enumeration Date 2009-12-14
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 8940 N KENDALL DR # 1005E
MIAMI, FL 33176-2148
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 13195 SW 134TH ST 2ND FLOOR
MIAMI, FL 33186-4461
United States

Phone: 305-274-2499 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice FL DN18878