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Organization
AESTHETIC DENTAL PA
Active
Organization
AESTHETIC DENTAL PA
Active
Other names
Trust Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SANDOR JAVIER VALLS DMD (OWNER/DENTIST)
(305) 557-5775
Entity
Organization
Contact information
Practice address
15436 NW 77TH CT, MIAMI LAKES, FL 33016-5822
(305) 557-5775
Mailing address
9451 SW 192ND DR, CUTLER BAY, FL 33157-7933
(786) 970-9723
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194255539
CMS
FL
01
—
1497372999
CMS
FL
01
—
1851851968
CMS
—
Enumeration date
12/23/2024
Last updated
12/23/2024
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