Provider Demographics
NPI:1851688303
Name:PROFESSIONAL DENTAL SOLUTIONS, INC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GERTRUDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-693-7988
Mailing Address - Street 1:7900 NW 27 AVE.
Mailing Address - Street 2:#275
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147
Mailing Address - Country:US
Mailing Address - Phone:305-693-7988
Mailing Address - Fax:305-693-6704
Practice Address - Street 1:7900 NW 27 AVE.
Practice Address - Street 2:#275
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147
Practice Address - Country:US
Practice Address - Phone:305-693-7988
Practice Address - Fax:305-693-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty