Provider Demographics
NPI:1225773187
Name:TATIANA H REINO AGOSTO DDS PA
Entity Type:Organization
Organization Name:TATIANA H REINO AGOSTO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:REINO AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-685-5878
Mailing Address - Street 1:7235 CORAL WAY SUITE #203
Mailing Address - Street 2:2651NW 84TH AVE APT 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122
Mailing Address - Country:US
Mailing Address - Phone:786-685-5878
Mailing Address - Fax:
Practice Address - Street 1:7235 CORAL WAY STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1451
Practice Address - Country:US
Practice Address - Phone:786-344-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center