Provider Demographics
NPI:1235773466
Name:BLUE DENTAL STUDIO INC
Entity Type:Organization
Organization Name:BLUE DENTAL STUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GARCIA PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-583-9178
Mailing Address - Street 1:9251 W FLAGLER ST STE B107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2410
Mailing Address - Country:US
Mailing Address - Phone:786-634-1072
Mailing Address - Fax:
Practice Address - Street 1:9251 W FLAGLER ST STE B107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2410
Practice Address - Country:US
Practice Address - Phone:786-634-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty