Provider Demographics
NPI:1184186454
Name:UNITED DENTAL GROUP
Entity Type:Organization
Organization Name:UNITED DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-464-0584
Mailing Address - Street 1:10300 SW 72ND ST STE 358
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3020
Mailing Address - Country:US
Mailing Address - Phone:786-464-0584
Mailing Address - Fax:786-464-0721
Practice Address - Street 1:10300 SW 72ND ST STE 358
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3020
Practice Address - Country:US
Practice Address - Phone:786-464-0584
Practice Address - Fax:786-464-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty