Provider Demographics
NPI:1801231444
Name:MED DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MED DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-437-2117
Mailing Address - Street 1:7200 NW 7TH ST STE 333
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2955
Mailing Address - Country:US
Mailing Address - Phone:305-264-0063
Mailing Address - Fax:305-264-0065
Practice Address - Street 1:7200 NW 7TH ST STE 333
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2955
Practice Address - Country:US
Practice Address - Phone:305-264-0063
Practice Address - Fax:305-264-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17094261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076093500Medicaid