Provider Demographics
NPI:1689887325
Name:COSMETIC DENTISTRY CORPORATION
Entity Type:Organization
Organization Name:COSMETIC DENTISTRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-531-7977
Mailing Address - Street 1:960 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3326
Mailing Address - Country:US
Mailing Address - Phone:305-531-7977
Mailing Address - Fax:305-531-7970
Practice Address - Street 1:960 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3326
Practice Address - Country:US
Practice Address - Phone:305-531-7977
Practice Address - Fax:305-531-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-15193305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization