Provider Demographics
NPI:1225316888
Name:ELIZABETH DE AGUIRRE DDS PA
Entity Type:Organization
Organization Name:ELIZABETH DE AGUIRRE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-446-2226
Mailing Address - Street 1:475 BILTMORE WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5736
Mailing Address - Country:US
Mailing Address - Phone:305-446-2226
Mailing Address - Fax:305-446-8458
Practice Address - Street 1:475 BILTMORE WAY STE 301
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5736
Practice Address - Country:US
Practice Address - Phone:305-446-2226
Practice Address - Fax:305-446-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0015008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001666800Medicaid