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Organization
ICOM HIALEAH LLC
Active
Organization
ICOM HIALEAH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATIANA SANTIAGO HERZOG (DENTIST)
(305) 409-5392
Entity
Organization
Contact information
Practice address
6600 W 12TH AVE, HIALEAH, FL 33012-6450
(305) 846-7987
(786) 221-4442
Mailing address
611 NE 13TH ST, FT LAUDERDALE, FL 33304-1109
(305) 846-7987
(786) 221-4442
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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