Provider Demographics
NPI:1225570963
Name:K DENTAL CORP
Entity Type:Organization
Organization Name:K DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TORRES BUSTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-387-3002
Mailing Address - Street 1:13550 SW 88TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1543
Mailing Address - Country:US
Mailing Address - Phone:305-387-3002
Mailing Address - Fax:
Practice Address - Street 1:13550 SW 88TH ST STE 170
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1543
Practice Address - Country:US
Practice Address - Phone:305-387-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21582122300000X
FLDN 21512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty