Provider Demographics
NPI:1538463443
Name:ACADIA FAMILY DENTAL, ORTHODONTIC, AND IMPLANT CENTER LLC
Entity Type:Organization
Organization Name:ACADIA FAMILY DENTAL, ORTHODONTIC, AND IMPLANT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:SOLOMON
Authorized Official - Last Name:SEVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-621-3111
Mailing Address - Street 1:19517 NW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4709
Mailing Address - Country:US
Mailing Address - Phone:305-621-3111
Mailing Address - Fax:
Practice Address - Street 1:19517 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4709
Practice Address - Country:US
Practice Address - Phone:305-621-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty