Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS AT LONDON SQUARE, PA
Active
Other names
Dental Associates of West Kendall
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE GOMEZ (PROVIDER RELATIONS SPECIALIST)
(305) 274-2499
Entity
Organization
Contact information
Practice address
13400 SW 120TH ST, STE 310, MIAMI, FL 33186-7440
(305) 255-9541
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
DN5380
FL
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
10/30/2009
Last updated
08/04/2014
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