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12002 Sw 128th Ct Ste 210 Miami FL 33186-4643 | |
| (786) 776-3328 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12002 Sw 128th Ct Ste 210, Miami, Florida |
| Authorized Official Name and Position | Elena M Solis Gonzalez (OWNER) |
| Authorized Official Contact | 5612670906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12002 Sw 128th Ct Ste 210 Miami FL 33186-4643 Ph: (786) 776-3328 | 12002 Sw 128th Ct Ste 210 Miami FL 33186-4643 Ph: (786) 776-3328 |
| NPI Number | 1568949048 |
|---|---|
| Provider Enumeration Date | 07/26/2018 |
| Last Update Date | 07/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568949048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN20240 (Florida) | Primary |
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