Provider Demographics
NPI:1659770592
Name:FRED PEDROLETTI DMD PA
Entity Type:Organization
Organization Name:FRED PEDROLETTI DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-790-3130
Mailing Address - Street 1:7231 SW 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4809
Mailing Address - Country:US
Mailing Address - Phone:305-667-1191
Mailing Address - Fax:
Practice Address - Street 1:7231 SW 63RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4809
Practice Address - Country:US
Practice Address - Phone:305-667-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI OMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-16
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17712261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental