Provider Demographics
NPI:1235465519
Name:FLAGLER DENTAL CARE
Entity Type:Organization
Organization Name:FLAGLER DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-324-5072
Mailing Address - Street 1:1199 W FLAGLER ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1055
Mailing Address - Country:US
Mailing Address - Phone:305-324-5072
Mailing Address - Fax:305-403-2981
Practice Address - Street 1:1199 W FLAGLER ST STE 7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1055
Practice Address - Country:US
Practice Address - Phone:305-324-5072
Practice Address - Fax:305-403-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty