Provider Demographics
NPI:1417450404
Name:DORGIS DENTAL, P.A.
Entity Type:Organization
Organization Name:DORGIS DENTAL, P.A.
Other - Org Name:KINDLY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-474-0400
Mailing Address - Street 1:18652 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2406
Mailing Address - Country:US
Mailing Address - Phone:305-474-0400
Mailing Address - Fax:305-474-0094
Practice Address - Street 1:18652 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-474-0400
Practice Address - Fax:305-474-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20258261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental