Provider Demographics
NPI:1972854149
Name:FLORIDA CHILDREN'S DENTISTRY, P.A.
Entity Type:Organization
Organization Name:FLORIDA CHILDREN'S DENTISTRY, P.A.
Other - Org Name:ANIA CABRERIZO DMD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FETNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-825-9899
Mailing Address - Street 1:4410 W 16TH AVE STE 47
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7193
Mailing Address - Country:US
Mailing Address - Phone:305-825-9899
Mailing Address - Fax:
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:#52
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7100
Practice Address - Country:US
Practice Address - Phone:305-825-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114162202Medicaid
FL114162200Medicaid
FL114162201Medicaid
FL114162205Medicaid