Provider Demographics
NPI:1972877215
Name:FLORIDA CITY DENTAL
Entity Type:Organization
Organization Name:FLORIDA CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-242-5777
Mailing Address - Street 1:103 E LUCY ST # 125
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2501
Mailing Address - Country:US
Mailing Address - Phone:305-242-5777
Mailing Address - Fax:305-242-5722
Practice Address - Street 1:103 E LUCY ST # 125
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-2501
Practice Address - Country:US
Practice Address - Phone:305-242-5777
Practice Address - Fax:305-242-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty