Provider Demographics
NPI:1326655408
Name:BEDSIDE DENTAL SERVICES
Entity Type:Organization
Organization Name:BEDSIDE DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-247-8253
Mailing Address - Street 1:15654 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2627
Mailing Address - Country:US
Mailing Address - Phone:786-247-8253
Mailing Address - Fax:
Practice Address - Street 1:15654 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2627
Practice Address - Country:US
Practice Address - Phone:786-247-8253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty