Provider Demographics
NPI:1437594330
Name:AVENTURA CENTER FOR DENTAL SLEEP MEDICINE, INC
Entity Type:Organization
Organization Name:AVENTURA CENTER FOR DENTAL SLEEP MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:FREEDLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-932-9202
Mailing Address - Street 1:1948 N OAK HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2627 NE 203RD ST
Practice Address - Street 2:SUITE 212
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1900
Practice Address - Country:US
Practice Address - Phone:305-932-9202
Practice Address - Fax:305-932-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center