Provider Demographics
NPI:1184815599
Name:NORTH WEST DENTAL CENTER, CORP.
Entity Type:Organization
Organization Name:NORTH WEST DENTAL CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:MAGARITA
Authorized Official - Last Name:CABEZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-576-4387
Mailing Address - Street 1:157 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3107
Mailing Address - Country:US
Mailing Address - Phone:305-576-4387
Mailing Address - Fax:305-576-1166
Practice Address - Street 1:157 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3107
Practice Address - Country:US
Practice Address - Phone:305-576-4387
Practice Address - Fax:305-576-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-95611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty