Provider Demographics
NPI:1649746264
Name:YR COLLAZO DMD LLC
Entity Type:Organization
Organization Name:YR COLLAZO DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-238-7590
Mailing Address - Street 1:285 NW 27TH AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5134
Mailing Address - Country:US
Mailing Address - Phone:786-238-7590
Mailing Address - Fax:305-503-6760
Practice Address - Street 1:285 NW 27TH AVE STE 21
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5134
Practice Address - Country:US
Practice Address - Phone:786-238-7590
Practice Address - Fax:305-503-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental