Provider Demographics
NPI:1346702917
Name:FG DENTAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:FG DENTAL SOLUTIONS LLC
Other - Org Name:FG FAMILY AND IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:YARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEITAS PERDOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-370-0147
Mailing Address - Street 1:5981 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7225
Mailing Address - Country:US
Mailing Address - Phone:786-370-0147
Mailing Address - Fax:
Practice Address - Street 1:5981 STIRLING RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7225
Practice Address - Country:US
Practice Address - Phone:786-370-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental