Provider Demographics
NPI:1427553890
Name:DESIGN A SMILE KENDALL PA
Entity Type:Organization
Organization Name:DESIGN A SMILE KENDALL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-667-8887
Mailing Address - Street 1:6437 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4827
Mailing Address - Country:US
Mailing Address - Phone:305-667-8887
Mailing Address - Fax:305-667-2166
Practice Address - Street 1:13091 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1708
Practice Address - Country:US
Practice Address - Phone:305-408-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14151261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014938900Medicaid