# GATEWAY DENTAL INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760868863
- **Authorized official:** DR. PABLO MIRANDA D.M.D. (OWNER)
- **Authorized official phone:** (305) 552-1553

## Contact information

- **Practice address:** 11880 SW 40TH ST, SUITE 215, MIAMI, FL 33175-3584
- **Practice address phone:** (305) 552-1553
- **Practice address fax:** (305) 325-0935
- **Mailing address:** 11880 SW 40TH ST, SUITE 215, MIAMI, FL 33175-3584
- **Mailing address phone:** (305) 552-1553
- **Mailing address fax:** (305) 325-0935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN15212 | FL | Yes |

## Other

- **Enumeration date:** 07/31/2015
- **Last updated:** 07/23/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 101379200 | — | FL |