Organization
DENTAL SPECIALISTS OF HOMESTEAD
Active
Other names
Dental Specialists of Homestead
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN PELTON DMD (ADMINISTRATIVE OPERATOR)
(305) 530-8115
Entity
Organization
Contact information
Practice address
190 NW 14TH ST, HOMESTEAD, FL 33030-4240
(786) 355-4401
(305) 220-9966
Mailing address
10666 FONTAINEBLEAU BLVD, MIAMI, FL 33172-3117
(305) 220-8911
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P435417372860
DRIVERS LICENSE
FL
Enumeration date
11/15/2019
Last updated
11/15/2019
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