Provider Demographics
NPI:1013050137
Name:AMERICA DENTAL CLINIC
Entity Type:Organization
Organization Name:AMERICA DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIENTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-485-8427
Mailing Address - Street 1:3631 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4307
Mailing Address - Country:US
Mailing Address - Phone:305-485-8427
Mailing Address - Fax:305-485-8429
Practice Address - Street 1:3631 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4307
Practice Address - Country:US
Practice Address - Phone:305-485-8427
Practice Address - Fax:305-485-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16661122300000X
FLDN 17091122300000X
FLDN 15053122300000X
FLDN 12879122300000X
FLDN 179311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty