Organization
VIDAMAX DENTAL GROUP CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAISA CORTES FONTANET (OWNER)
(786) 715-5571
Entity
Organization
Contact information
Practice address
2040 WASHINGTON ST, HOLLYWOOD, FL 33020-6930
(754) 348-5001
Mailing address
2040 WASHINGTON ST, HOLLYWOOD, FL 33020-6930
(754) 348-5001
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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