1912280603 NPI number — TAMIAMI DENTAL CENTER, PA

Table of content: (NPI 1912280603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912280603 NPI number — TAMIAMI DENTAL CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMIAMI DENTAL CENTER, PA
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:
1912280603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13232 SW 8TH 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:
33184-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-553-9655
Provider Business Mailing Address Fax Number:
305-553-9688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13232 SW 8TH ST
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:
33184-1176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-553-9655
Provider Business Practice Location Address Fax Number:
305-553-9688
Provider Enumeration Date:
09/20/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FERRER
Authorized Official First Name:
GABBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
305-553-9655

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DN16637 , 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)

  • Identifier: DN19023 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DN15661 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DN19051 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DN16385 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DN16637 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".