Provider Demographics
NPI:1710140546
Name:SOUTH DENTAL AT HAMMOCKS, INC
Entity Type:Organization
Organization Name:SOUTH DENTAL AT HAMMOCKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-388-7599
Mailing Address - Street 1:16233 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4912
Mailing Address - Country:US
Mailing Address - Phone:305-383-2090
Mailing Address - Fax:305-408-6924
Practice Address - Street 1:16233 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4912
Practice Address - Country:US
Practice Address - Phone:305-383-2090
Practice Address - Fax:305-408-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty