Provider Demographics
NPI:1477217313
Name:E & G PEDIATRIC DENTISTRY PA
Entity Type:Organization
Organization Name:E & G PEDIATRIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LINA
Authorized Official - Last Name:GONZALEZ CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-303-3285
Mailing Address - Street 1:224 THREE ISLANDS BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 N FEDERAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3478
Practice Address - Country:US
Practice Address - Phone:954-233-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty