Provider Demographics
NPI:1245582600
Name:METROPOLITAN DENTAL SERVICES
Entity Type:Organization
Organization Name:METROPOLITAN DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:GRULLON
Authorized Official - Last Name:CORTORREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-364-5056
Mailing Address - Street 1:6969 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1705
Mailing Address - Country:US
Mailing Address - Phone:305-364-5056
Mailing Address - Fax:305-364-5061
Practice Address - Street 1:6969 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1705
Practice Address - Country:US
Practice Address - Phone:305-364-5056
Practice Address - Fax:305-364-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11432261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental