Provider Demographics
NPI:1033879580
Name:IGLESIAS, HAISSEL BERIOSCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAISSEL
Middle Name:BERIOSCA
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HAISSEL
Other - Middle Name:BERIOSCA
Other - Last Name:RAMIREZ DE OLEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1963 NW 136TH AVE APT 643
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5362
Mailing Address - Country:US
Mailing Address - Phone:202-674-9121
Mailing Address - Fax:
Practice Address - Street 1:8890 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5803
Practice Address - Country:US
Practice Address - Phone:954-341-0500
Practice Address - Fax:954-775-0547
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN265811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice