Provider Demographics
NPI:1366835860
Name:SUPERIOR DENTAL TEAM LLC
Entity Type:Organization
Organization Name:SUPERIOR DENTAL TEAM LLC
Other - Org Name:SUPERIOR DENTAL TEAM INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:LLEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-360-6262
Mailing Address - Street 1:148 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5250
Mailing Address - Country:US
Mailing Address - Phone:786-360-6262
Mailing Address - Fax:
Practice Address - Street 1:148 HIALEAH DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5250
Practice Address - Country:US
Practice Address - Phone:786-360-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization