Provider Demographics
NPI:1215363056
Name:AOD DENTAL CLINIC
Entity Type:Organization
Organization Name:AOD DENTAL CLINIC
Other - Org Name:AOD DENTAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:DEANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-444-2404
Mailing Address - Street 1:2901 S BAYSHORE DR APT 4F
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6001
Mailing Address - Country:US
Mailing Address - Phone:305-444-2404
Mailing Address - Fax:
Practice Address - Street 1:8000 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4621
Practice Address - Country:US
Practice Address - Phone:786-517-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7784261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental