Provider Demographics
NPI:1609233519
Name:ULTRA DENTAL CARE
Entity Type:Organization
Organization Name:ULTRA DENTAL CARE
Other - Org Name:ULTRA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUNBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-835-0413
Mailing Address - Street 1:6801 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4742
Mailing Address - Country:US
Mailing Address - Phone:305-835-0413
Mailing Address - Fax:305-456-2118
Practice Address - Street 1:6801 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4742
Practice Address - Country:US
Practice Address - Phone:305-835-0413
Practice Address - Fax:305-456-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty