Provider Demographics
NPI:1477819571
Name:ORAL & FACIAL SURGERY OF MIAMI, LLC
Entity Type:Organization
Organization Name:ORAL & FACIAL SURGERY OF MIAMI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-271-3341
Mailing Address - Street 1:3860 SW 8TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-552-1193
Mailing Address - Fax:305-443-0008
Practice Address - Street 1:3860 SW 8TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-552-1193
Practice Address - Fax:305-443-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty