Provider Demographics
NPI:1639403868
Name:BALMIR-THEVENIN & ASSOCIATES D.D.S., P.A.,
Entity Type:Organization
Organization Name:BALMIR-THEVENIN & ASSOCIATES D.D.S., P.A.,
Other - Org Name:BALMIR-THEVENIN & ASSOCIATES D.D.S., P.A.,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOELLE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALMIR-THEVENIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-271-0510
Mailing Address - Street 1:10621 N KENDALL DR
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8708
Mailing Address - Country:US
Mailing Address - Phone:305-271-0510
Mailing Address - Fax:305-271-3532
Practice Address - Street 1:10621 N KENDALL DR
Practice Address - Street 2:SUITE # 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8708
Practice Address - Country:US
Practice Address - Phone:305-271-0510
Practice Address - Fax:305-271-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013260122300000X
FLBC11023361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071317100Medicaid
FL1972618361OtherNPI