Provider Demographics
NPI:1407398969
Name:AMERICAN PEDIATRIC DENTAL KENDALL, INC.
Entity Type:Organization
Organization Name:AMERICAN PEDIATRIC DENTAL KENDALL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL AND COMPLIANCE DIR.
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:804-304-5437
Mailing Address - Street 1:8200 SW 117TH AVE
Mailing Address - Street 2:STE. 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3856
Mailing Address - Country:US
Mailing Address - Phone:804-304-5437
Mailing Address - Fax:
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:STE. 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:804-304-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty