Provider Demographics
NPI:1710994934
Name:MEDINA, NANCY (DMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 NE 190TH ST APT 2807
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2465
Mailing Address - Country:US
Mailing Address - Phone:305-333-0370
Mailing Address - Fax:
Practice Address - Street 1:2905 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4212
Practice Address - Country:US
Practice Address - Phone:954-392-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics