Provider Demographics
NPI:1982814687
Name:KENWARD AND MAYORAL DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:KENWARD AND MAYORAL DENTISTRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-255-7722
Mailing Address - Street 1:12651 S DIXIE HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5956
Mailing Address - Country:US
Mailing Address - Phone:305-255-7722
Mailing Address - Fax:305-255-2152
Practice Address - Street 1:12651 S DIXIE HWY STE 400
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5956
Practice Address - Country:US
Practice Address - Phone:305-255-7722
Practice Address - Fax:305-255-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116441223G0001X
FLDN85551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty