Organization
LIVE IMPLANTS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGILIO J MONGALO DMD (DOCTOR)
(786) 249-4514
Entity
Organization
Contact information
Practice address
18001 OLD CUTLER RD STE 405, PALMETTO BAY, FL 33157-6434
(786) 249-4514
Mailing address
18001 OLD CUTLER RD STE 405, PALMETTO BAY, FL 33157-6434
(786) 249-4514
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2021
Last updated
07/02/2021
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