Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF HOMESTEAD, P.A.
Active
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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