Provider Demographics
NPI:1528601747
Name:DENTAL SERVICES OF AVENTURA, PA
Entity Type:Organization
Organization Name:DENTAL SERVICES OF AVENTURA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-258-9838
Mailing Address - Street 1:2630 NE 203RD STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1903
Mailing Address - Country:US
Mailing Address - Phone:305-258-9838
Mailing Address - Fax:
Practice Address - Street 1:2630 NE 203RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1903
Practice Address - Country:US
Practice Address - Phone:305-258-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty