Provider Demographics
NPI:1164143681
Name:R M DENTAL OF PEMBROKE PINES PA
Entity Type:Organization
Organization Name:R M DENTAL OF PEMBROKE PINES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-410-0625
Mailing Address - Street 1:15280 SW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3643
Mailing Address - Country:US
Mailing Address - Phone:787-410-0625
Mailing Address - Fax:
Practice Address - Street 1:601 NW 179TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2819
Practice Address - Country:US
Practice Address - Phone:954-450-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty