Provider Demographics
NPI:1417298118
Name:DENTAL R US
Entity Type:Organization
Organization Name:DENTAL R US
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-253-7588
Mailing Address - Street 1:11373 SW 211TH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2246
Mailing Address - Country:US
Mailing Address - Phone:305-253-7588
Mailing Address - Fax:
Practice Address - Street 1:11373 SW 211TH ST STE 11
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2246
Practice Address - Country:US
Practice Address - Phone:305-253-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty