Provider Demographics
NPI:1003154261
Name:DENTAL SPECIALISTS OF DORAL GROUP
Entity Type:Organization
Organization Name:DENTAL SPECIALISTS OF DORAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-355-4401
Mailing Address - Street 1:10305 NW 41ST ST
Mailing Address - Street 2:# 207
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2396
Mailing Address - Country:US
Mailing Address - Phone:786-355-4401
Mailing Address - Fax:
Practice Address - Street 1:10305 SW 41 ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:786-355-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty