Provider Demographics
NPI:1508112970
Name:SENIOR DENTAL LLC
Entity Type:Organization
Organization Name:SENIOR DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-444-1244
Mailing Address - Street 1:351 NW 42ND AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5683
Mailing Address - Country:US
Mailing Address - Phone:305-642-3552
Mailing Address - Fax:
Practice Address - Street 1:351 NW 42ND AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:305-642-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental