Provider Demographics
NPI:1740615418
Name:DENTAL SPECIALISTS OF CORAL GABLES GROUP CO.
Entity Type:Organization
Organization Name:DENTAL SPECIALISTS OF CORAL GABLES GROUP CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTARTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-9601
Mailing Address - Street 1:2645 SW 37TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2744
Mailing Address - Country:US
Mailing Address - Phone:305-305-9601
Mailing Address - Fax:305-593-6520
Practice Address - Street 1:2645 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-305-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty