Provider Demographics
NPI:1568613966
Name:A O D DENTAL CLINIC
Entity Type:Organization
Organization Name:A O D DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:DE ANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-222-1150
Mailing Address - Street 1:2901 S BAYSHORE DR APT 4F
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6001
Mailing Address - Country:US
Mailing Address - Phone:305-476-0230
Mailing Address - Fax:
Practice Address - Street 1:11865 SW 26TH ST STE G10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2471
Practice Address - Country:US
Practice Address - Phone:305-222-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL77841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty