Provider Demographics
NPI:1467993501
Name:SUAREZ COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:SUAREZ COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-922-6873
Mailing Address - Street 1:3801 PARK ST N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4078
Mailing Address - Country:US
Mailing Address - Phone:787-922-6873
Mailing Address - Fax:877-257-6092
Practice Address - Street 1:3801 PARK ST N
Practice Address - Street 2:SUITE 1
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4078
Practice Address - Country:US
Practice Address - Phone:787-922-6873
Practice Address - Fax:877-257-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016295100Medicaid