Provider Demographics
NPI:1437603446
Name:DORAL PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:DORAL PEDIATRIC DENTISTRY
Other - Org Name:KENDALL PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARRASTAZU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-251-5390
Mailing Address - Street 1:13757 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-8125
Mailing Address - Country:US
Mailing Address - Phone:305-251-5390
Mailing Address - Fax:
Practice Address - Street 1:13757 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-8125
Practice Address - Country:US
Practice Address - Phone:305-251-5390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORAL PEDIATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty