Provider Demographics
NPI:1689845158
Name:ECHEZARRAGA, MILAIDIS
Entity Type:Individual
Prefix:DR
First Name:MILAIDIS
Middle Name:
Last Name:ECHEZARRAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13920 SW 47TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4405
Mailing Address - Country:US
Mailing Address - Phone:305-480-6044
Mailing Address - Fax:305-480-6081
Practice Address - Street 1:13920 SW 47TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4405
Practice Address - Country:US
Practice Address - Phone:305-480-6044
Practice Address - Fax:305-480-6081
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 175781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice