Organization
MAIN STREET CHILDREN'S DENTISTRY OF MIAMI LAKES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (PROVIDER RELATIONS)
(305) 274-2499
Entity
Organization
Contact information
Practice address
15501 NW 67TH AVE STE 201, MIAMI LAKES, FL 33014-2108
(786) 577-4968
Mailing address
15501 NW 67TH AVE STE 201, MIAMI LAKES, FL 33014-2108
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/11/2014
Last updated
06/23/2015
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