1730602780 NPI number — GIOVANNI ALEXANDER ALDAMA DMD

Table of content: GIOVANNI ALEXANDER ALDAMA DMD (NPI 1730602780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730602780 NPI number — GIOVANNI ALEXANDER ALDAMA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALDAMA
Provider First Name:
GIOVANNI
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

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:
1730602780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2253 SW 10TH ST
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:
33135-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-301-2474
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
348 ALHAMBRA CIR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33134-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-317-9887
Provider Business Practice Location Address Fax Number:
305-513-5175
Provider Enumeration Date:
07/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  10575 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 22599 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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