Provider Demographics
NPI:1528601846
Name:AFFORDABLE DENTURES & IMPLANTS - MIAMI LAKES III, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - MIAMI LAKES III, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-628-9956
Mailing Address - Street 1:16201 NW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6709
Mailing Address - Country:US
Mailing Address - Phone:305-628-9956
Mailing Address - Fax:
Practice Address - Street 1:16201 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6709
Practice Address - Country:US
Practice Address - Phone:305-628-9956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty