Provider Demographics
NPI:1316187784
Name:HARATZ, ADELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADELA
Middle Name:
Last Name:HARATZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADELA
Other - Middle Name:
Other - Last Name:HARATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3040 NE 190TH ST
Mailing Address - Street 2:APT# 304
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3141
Mailing Address - Country:US
Mailing Address - Phone:754-423-5416
Mailing Address - Fax:
Practice Address - Street 1:3040 NE 190TH ST
Practice Address - Street 2:APT# 304
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3141
Practice Address - Country:US
Practice Address - Phone:754-423-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist