Provider Demographics
NPI:1922122639
Name:CORAL REEF DENTAL CENTER
Entity Type:Organization
Organization Name:CORAL REEF DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:VUELTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-235-4075
Mailing Address - Street 1:14981 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7929
Mailing Address - Country:US
Mailing Address - Phone:305-235-4075
Mailing Address - Fax:305-235-4167
Practice Address - Street 1:14981 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7929
Practice Address - Country:US
Practice Address - Phone:305-235-4075
Practice Address - Fax:305-235-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11392305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization