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21457 Nw 2nd Ave Miami FL 33169-2120 | |
| (305) 654-1234 | |
| (484) 348-0322 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 21457 Nw 2nd Ave, Miami, Florida |
| Authorized Official Name and Position | Igor Pasisnitchenko (MEMBER) |
| Authorized Official Contact | 3056541234 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
21457 Nw 2nd Ave Miami FL 33169-2120 Ph: (305) 654-1234 | 21457 Nw 2nd Ave Miami FL 33169-2120 Ph: (305) 654-1234 |
| NPI Number | 1063620789 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063620789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN15470 (Florida) | Primary |
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