Provider Demographics
NPI:1417348467
Name:HEALTH AND COSMETIC DENTAL CARE PA
Entity Type:Organization
Organization Name:HEALTH AND COSMETIC DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GRETELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-646-9222
Mailing Address - Street 1:4150 NW 7TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5535
Mailing Address - Country:US
Mailing Address - Phone:305-646-9222
Mailing Address - Fax:305-646-6704
Practice Address - Street 1:4150 NW 7TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5535
Practice Address - Country:US
Practice Address - Phone:305-646-9222
Practice Address - Fax:305-646-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19927261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008147300Medicaid