Provider Demographics
NPI:1962501411
Name:PERIODONTAL SOLUTIONS OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:PERIODONTAL SOLUTIONS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:3055-665-6575
Mailing Address - Street 1:7600 RED ROAD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-665-6575
Mailing Address - Fax:305-661-7076
Practice Address - Street 1:7600 RED ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-665-6575
Practice Address - Fax:305-661-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00141361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty