Organization
MGM DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA GABRIELA MOGOLLON DDS (OWNER)
(786) 597-1636
Entity
Organization
Contact information
Practice address
15659 SW 88TH ST, MIAMI, FL 33196
(786) 558-7315
(786) 558-7318
Mailing address
15659 SW 88TH ST, MIAMI, FL 33196-1103
(786) 558-7315
(786) 558-7318
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QD0000X
Dental Clinic/Center
Primary
DN20484
FL
Other
Enumeration date
03/11/2011
Last updated
07/02/2018
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