Organization
PRIME PEDIATRIC DENTAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE MELLADO (PRESIDENT)
(305) 321-3790
Entity
Organization
Contact information
Practice address
4919 SHERIDAN ST UNIT 50-51, HOLLYWOOD, FL 33021-2823
(305) 251-5390
Mailing address
13757 SW 152ND ST, MIAMI, FL 33177-8125
(305) 251-5390
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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