Provider Demographics
NPI:1679058572
Name:CARDENAS, MAXWELL (DDS)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1631
Mailing Address - Country:US
Mailing Address - Phone:305-223-7766
Mailing Address - Fax:305-223-7434
Practice Address - Street 1:10500 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1631
Practice Address - Country:US
Practice Address - Phone:305-223-7766
Practice Address - Fax:305-223-7434
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH24862124Q00000X
FLDN262731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist