Provider Demographics
NPI:1508242876
Name:DADE COUNTY DENTAL RESEARCH CENTER
Entity Type:Organization
Organization Name:DADE COUNTY DENTAL RESEARCH CENTER
Other - Org Name:COMMUNITY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:305-363-2218
Mailing Address - Street 1:750 NW 20TH ST # G-110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-4618
Mailing Address - Country:US
Mailing Address - Phone:305-363-2218
Mailing Address - Fax:
Practice Address - Street 1:750 NW 20TH ST # G-110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4618
Practice Address - Country:US
Practice Address - Phone:305-363-2218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14199302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherHMO