Provider Demographics
NPI:1760964977
Name:ORAL SURGERY & IMPLANT CENTER
Entity Type:Organization
Organization Name:ORAL SURGERY & IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-667-1191
Mailing Address - Street 1:7231 SW 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4809
Mailing Address - Country:US
Mailing Address - Phone:305-667-1191
Mailing Address - Fax:305-667-2712
Practice Address - Street 1:7231 SW 63RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4809
Practice Address - Country:US
Practice Address - Phone:305-667-1191
Practice Address - Fax:305-667-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery