Provider Demographics
NPI:1245404110
Name:CLARA M. MACIAS, D.M.D. P.A.
Entity Type:Organization
Organization Name:CLARA M. MACIAS, D.M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-252-0806
Mailing Address - Street 1:6830 DYKES RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4663
Mailing Address - Country:US
Mailing Address - Phone:954-252-0806
Mailing Address - Fax:954-252-6685
Practice Address - Street 1:6830 DYKES RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-4663
Practice Address - Country:US
Practice Address - Phone:954-252-0806
Practice Address - Fax:954-252-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty