Provider Demographics
NPI:1023565033
Name:PROGRESSIVE DENTAL OFFICE CORP
Entity Type:Organization
Organization Name:PROGRESSIVE DENTAL OFFICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:AYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-829-0100
Mailing Address - Street 1:18600 NW 87TH AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3512
Mailing Address - Country:US
Mailing Address - Phone:305-829-0100
Mailing Address - Fax:305-829-7979
Practice Address - Street 1:18600 NW 87TH AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3512
Practice Address - Country:US
Practice Address - Phone:305-829-0100
Practice Address - Fax:305-829-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN150531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty