1720373889 NPI number — EXCLUSIVE DENTAL CARE GROUP, INC

Table of content: (NPI 1720373889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720373889 NPI number — EXCLUSIVE DENTAL CARE GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCLUSIVE DENTAL CARE GROUP, INC
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:
6
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:
1720373889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7150 W 20TH AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-5509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-392-1942
Provider Business Mailing Address Fax Number:
305-456-7234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7150 W 20TH AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33016-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-798-4041
Provider Business Practice Location Address Fax Number:
789-442-2186
Provider Enumeration Date:
06/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA
Authorized Official First Name:
CELIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-392-1942

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: 076867700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016591500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com