1114169505 NPI number — BILTMORE DENTAL ASSOCIATES P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114169505 NPI number — BILTMORE DENTAL ASSOCIATES P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILTMORE DENTAL ASSOCIATES P.A.
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114169505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11300 NW 87TH CT
Provider Second Line Business Mailing Address:
SUITE#166
Provider Business Mailing Address City Name:
HIALEAH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33018-4586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-364-9322
Provider Business Mailing Address Fax Number:
305-364-0983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11300 NW 87TH CT
Provider Second Line Business Practice Location Address:
SUITE#166
Provider Business Practice Location Address City Name:
HIALEAH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33018-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-364-9322
Provider Business Practice Location Address Fax Number:
305-364-0983
Provider Enumeration Date:
03/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEYVA
Authorized Official First Name:
EDRYS
Authorized Official Middle Name:
B
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
305-364-9322

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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