Provider Demographics
NPI:1760709901
Name:ESTHETIC DENTAL CLINIC, INC
Entity Type:Organization
Organization Name:ESTHETIC DENTAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ILVAIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HECHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-3698
Mailing Address - Street 1:3735 SW 8TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-448-3698
Mailing Address - Fax:305-448-6117
Practice Address - Street 1:3735 SW 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-448-3698
Practice Address - Fax:305-448-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty