Individual
DANIEL DE LA FUENTE BALBOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
12350 SW 127TH AVE, MIAMI, FL 33186-6595
(305) 232-2227
Mailing address
6060 SW 62ND PL, SOUTH MIAMI, FL 33143-2170
(786) 234-7051
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN24143
FL
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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