Provider Demographics
NPI:1083004089
Name:FLORIDIAN DENTAL AT KENDALL, PLLC
Entity Type:Organization
Organization Name:FLORIDIAN DENTAL AT KENDALL, PLLC
Other - Org Name:FLORIDIAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:MOSS
Authorized Official - Last Name:VINUELA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-258-1014
Mailing Address - Street 1:9001 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2066
Mailing Address - Country:US
Mailing Address - Phone:352-258-1014
Mailing Address - Fax:
Practice Address - Street 1:9595 N KENDALL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1979
Practice Address - Country:US
Practice Address - Phone:305-274-8253
Practice Address - Fax:305-274-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty