Individual
ELISSABET BANEGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
750 NW 20TH ST BLDG G10, MIAMI, FL 33127-4618
(305) 363-2222
Mailing address
750 NW 20TH ST BLDG G10, MIAMI, FL 33127-4618
(305) 363-2222
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401418868
VA
122300000X
Dentist
Primary
DN29448
FL
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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