Provider Demographics
NPI:1417606914
Name:BIODENT CLINIC LLC
Entity Type:Organization
Organization Name:BIODENT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAYLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-949-9987
Mailing Address - Street 1:4141 NE 2ND AVE STE 106A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4141 NE 2ND AVE STE 106A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3500
Practice Address - Country:US
Practice Address - Phone:786-487-3702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty