Organization
GATEWAY DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PABLO MIRANDA D.M.D. (OWNER)
(305) 552-1553
Entity
Organization
Contact information
Practice address
11880 SW 40TH ST, SUITE 215, MIAMI, FL 33175-3584
(305) 552-1553
(305) 325-0935
Mailing address
11880 SW 40TH ST, SUITE 215, MIAMI, FL 33175-3584
(305) 552-1553
(305) 325-0935
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15212
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101379200
—
FL
Enumeration date
07/31/2015
Last updated
07/23/2019
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