Organization
PEDO ORTHO DENTAL SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CRISCUOLO (DMD/OWNER)
(954) 268-9825
Entity
Organization
Contact information
Practice address
8950 SW 74TH CT STE 124, MIAMI, FL 33156-3171
(954) 268-9825
Mailing address
8950 SW 74TH CT STE 124, MIAMI, FL 33156-3171
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN21814
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008662900
—
FL
05
—
019273100
—
FL
Enumeration date
11/21/2017
Last updated
11/21/2017
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