Provider Demographics
NPI:1871687335
Name:LAGUNA DENTAL CORP
Entity Type:Organization
Organization Name:LAGUNA DENTAL CORP
Other - Org Name:DENTAL AMERICAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-225-3452
Mailing Address - Street 1:10721 W. FLAGLER STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1421
Mailing Address - Country:US
Mailing Address - Phone:305-225-3452
Mailing Address - Fax:305-225-7630
Practice Address - Street 1:10721 W FLAGLER STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1421
Practice Address - Country:US
Practice Address - Phone:305-225-3452
Practice Address - Fax:305-225-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 125931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty