Organization
DORAL PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN LUIS GARRASTAZU DMD (PRESIDENT)
(305) 513-4058
Entity
Organization
Contact information
Practice address
10717 NW 58TH ST, DORAL, FL 33178-2801
(305) 513-4058
(305) 639-2931
Mailing address
10717 NW 58TH ST, DORAL, FL 33178-2801
(305) 513-4058
(305) 639-2931
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
FL
Other
Enumeration date
04/12/2007
Last updated
09/06/2023
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