Provider Demographics
NPI:1346847134
Name:KENWARD & MAYORAL DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:KENWARD & MAYORAL DENTISTRY PARTNERSHIP
Other - Org Name:PINECREST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-670-8088
Mailing Address - Street 1:8950 SW 74TH CT STE 1212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3170
Mailing Address - Country:US
Mailing Address - Phone:305-670-8088
Mailing Address - Fax:
Practice Address - Street 1:8950 SW 74TH CT STE 1212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3170
Practice Address - Country:US
Practice Address - Phone:305-670-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty