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Organization
DENTAL SPECIALISTS OF HOMESTEAD
Active
Organization
DENTAL SPECIALISTS OF HOMESTEAD
Active
Other names
Dental Specialists of Homestead
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN PELTON DMD (ADMINISTRATIVE OPERATOR)
(305) 530-8115
Entity
Organization
Contact information
Practice address
190 NW 14TH ST, HOMESTEAD, FL 33030-4240
(786) 355-4401
(305) 220-9966
Mailing address
10666 FONTAINEBLEAU BLVD, MIAMI, FL 33172-3117
(305) 220-8911
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P435417372860
DRIVERS LICENSE
FL
Enumeration date
11/15/2019
Last updated
11/15/2019
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