Provider Demographics
NPI:1255658894
Name:SOUTHERN UNITED MANAGEMENT GROUP INC
Entity Type:Organization
Organization Name:SOUTHERN UNITED MANAGEMENT GROUP INC
Other - Org Name:DADE SOUTH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:EUTSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-233-6761
Mailing Address - Street 1:11371 SW 211TH ST
Mailing Address - Street 2:SUITE 27A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2244
Mailing Address - Country:US
Mailing Address - Phone:305-233-6761
Mailing Address - Fax:305-233-6791
Practice Address - Street 1:11371 SW 211TH ST
Practice Address - Street 2:SUITE 27A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2244
Practice Address - Country:US
Practice Address - Phone:305-233-6761
Practice Address - Fax:305-233-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty