Organization
SOUTH MIAMI DENTAL SERVICE PA
Active
Other names
Illustradent key biscayne
Organization subpart
No
Provider details
NPI number
Authorized official
MAYRA V PEREZ (ADMNISTRATOR)
(305) 361-5493
Entity
Organization
Contact information
Practice address
240 CRANDON BLVD, SUITE 104, KEY BISCAYNE, FL 33149
(305) 361-0351
(305) 361-2180
Mailing address
240 CRANDON BLVD, SUITE 104, KEY BISCAYNE, FL 33149
(305) 661-5360
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
DN18909
FL
Other
Enumeration date
05/27/2016
Last updated
05/27/2016
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