Organization
STLAB FLORIDA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS RODOLFO CASTRO CONCHA (OFFICE MANAGER)
(786) 237-5664
Entity
Organization
Contact information
Practice address
12177 SW 132ND CT, MIAMI, FL 33186-6410
(786) 237-5664
Mailing address
12177 SW 132ND CT, MIAMI, FL 33186-6410
(786) 237-5664
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2380187665136
FLORIDA REVENUE CERTIFICATE NUMBER
FL
01
—
DL12105
DENTAL LAB
FL
Enumeration date
11/09/2022
Last updated
11/09/2022
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