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Organization
PRO DENTAL CENTERS WEST HIALEAH
Active
Organization
PRO DENTAL CENTERS WEST HIALEAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUISA Y CORRALES -IGLESIAS ANNIE GARCIA (OFFICE MANAGER)
(305) 827-0434
Entity
Organization
Contact information
Practice address
400 W 65TH ST, HIALEAH, FL 33012-6640
(305) 827-0434
(305) 290-3194
Mailing address
400 W 65TH ST, HIALEAH, FL 33012-6640
(305) 827-0434
(305) 290-3194
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN17100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861546277
GENERAL DENTISTRY
FL
05
—
1861546277
—
FL
Enumeration date
08/16/2018
Last updated
08/16/2018
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