Provider Demographics
NPI:1891291860
Name:AMERICAN AESTHETIC DENTAL DORAL INC
Entity Type:Organization
Organization Name:AMERICAN AESTHETIC DENTAL DORAL INC
Other - Org Name:AMERICAN AESTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-304-5437
Mailing Address - Street 1:10021 PINES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6191
Mailing Address - Country:US
Mailing Address - Phone:844-304-5437
Mailing Address - Fax:954-417-1338
Practice Address - Street 1:7950 NW 53RD ST STE 201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4637
Practice Address - Country:US
Practice Address - Phone:844-304-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty