Provider Demographics
NPI:1619461639
Name:FACIAL SUBTLETIES
Entity Type:Organization
Organization Name:FACIAL SUBTLETIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-915-9087
Mailing Address - Street 1:975 ARTHUR GODFREY RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3350
Mailing Address - Country:US
Mailing Address - Phone:305-532-1728
Mailing Address - Fax:305-532-1729
Practice Address - Street 1:975 ARTHUR GODFREY RD STE 306
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3350
Practice Address - Country:US
Practice Address - Phone:305-532-1728
Practice Address - Fax:305-532-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21820122300000X
FL21820261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty