Provider Demographics
NPI:1205180445
Name:MAIGRELY ABREU-HERNANDEZ, DMD
Entity Type:Organization
Organization Name:MAIGRELY ABREU-HERNANDEZ, DMD
Other - Org Name:CASA SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIGRELY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-662-7702
Mailing Address - Street 1:5965 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2436
Mailing Address - Country:US
Mailing Address - Phone:305-662-7702
Mailing Address - Fax:305-662-2552
Practice Address - Street 1:5965 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2436
Practice Address - Country:US
Practice Address - Phone:305-662-7702
Practice Address - Fax:305-662-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0014724-00Medicaid