Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF HOMESTEAD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE GOMEZ (PROVIDER RELATIONS SPECIALIST)
(305) 274-2499
Entity
Organization
Contact information
Practice address
925 NE 30TH TER STE 110, HOMESTEAD, FL 33033-7614
(305) 274-2499
(305) 274-9312
Mailing address
13195 SW 134TH ST FL 2, MIAMI, FL 33186-4461
(305) 274-2499
(305) 274-9312
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/13/2011
Last updated
08/01/2014
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