| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 9210 Sw 72 St, Miami, Florida |
| Authorized Official Name and Position | Lina M Miranda (DENTIST/OWNER) |
| Authorized Official Contact | 3052750500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9210 Sw 72 St 103 Miami FL 33173 Ph: (305) 275-0500 | 9210 Sw 72 St 103 Miami FL 33173 Ph: (305) 275-0500 |
| NPI Number | 1750639357 |
|---|---|
| Provider Enumeration Date | 08/29/2012 |
| Last Update Date | 08/29/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750639357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN0010005 (Florida) | Primary |
| 261QD0000X | Clinic/center - Dental | DN19261 (Florida) | Secondary |
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