Provider Demographics
NPI:1629357694
Name:BISCAYNE DENTAL CENTER
Entity Type:Organization
Organization Name:BISCAYNE DENTAL CENTER
Other - Org Name:BISCAYNE DENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:IRAHETA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-945-7745
Mailing Address - Street 1:14771 BISCAYNE BLVD.
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33181
Mailing Address - Country:US
Mailing Address - Phone:305-945-7745
Mailing Address - Fax:305-945-7740
Practice Address - Street 1:14771 BISCAYNE BLVD.
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181
Practice Address - Country:US
Practice Address - Phone:305-945-7745
Practice Address - Fax:305-945-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty