Provider Demographics
NPI:1073929816
Name:C & C DENTAL, INC
Entity Type:Organization
Organization Name:C & C DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-493-9371
Mailing Address - Street 1:951 NE 167TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3711
Mailing Address - Country:US
Mailing Address - Phone:305-493-9371
Mailing Address - Fax:305-493-9428
Practice Address - Street 1:951 NE 167TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3711
Practice Address - Country:US
Practice Address - Phone:305-493-9371
Practice Address - Fax:305-493-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004027300Medicaid