1770263667 NPI number — FIRST CHOICE DENTAL IMPLANT CENTERS LLC

Table of content: (NPI 1770263667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770263667 NPI number — FIRST CHOICE DENTAL IMPLANT CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE DENTAL IMPLANT CENTERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1770263667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9101 SW 24TH ST STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33165-2083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-850-6687
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 SW 24TH ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33165-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-850-6687
Provider Business Practice Location Address Fax Number:
786-677-8963
Provider Enumeration Date:
07/24/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASTELLANOS
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
ANDRES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-586-5852

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DN23886 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".