Provider Demographics
NPI:1972095354
Name:LUCKY SEVEN FAMILY DENTISTRY CORP
Entity Type:Organization
Organization Name:LUCKY SEVEN FAMILY DENTISTRY CORP
Other - Org Name:LUCKY SEVEN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-507-1551
Mailing Address - Street 1:10511 SW 88TH ST STE C101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1537
Mailing Address - Country:US
Mailing Address - Phone:786-507-1551
Mailing Address - Fax:
Practice Address - Street 1:10511 SW 88TH ST STE C101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1537
Practice Address - Country:US
Practice Address - Phone:786-507-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN17467OtherDENTAL LIC