Provider Demographics
NPI:1407620503
Name:NEW LIFE DENTAL KENDALL
Entity Type:Organization
Organization Name:NEW LIFE DENTAL KENDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACCHIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-509-6337
Mailing Address - Street 1:8740 N KENDALL DR STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2221
Mailing Address - Country:US
Mailing Address - Phone:305-509-6337
Mailing Address - Fax:786-633-6926
Practice Address - Street 1:8740 N KENDALL DR STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2221
Practice Address - Country:US
Practice Address - Phone:305-509-6337
Practice Address - Fax:786-633-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty