Provider Demographics
NPI:1326256934
Name:NIN, FREDERICK JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSE
Last Name:NIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2737
Mailing Address - Country:US
Mailing Address - Phone:305-758-8755
Mailing Address - Fax:305-758-8740
Practice Address - Street 1:9425 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2737
Practice Address - Country:US
Practice Address - Phone:305-758-8755
Practice Address - Fax:305-758-8740
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN132341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice