Provider Demographics
NPI:1134377047
Name:A.N.A DENTAL SERVICES
Entity type:Organization
Organization Name:A.N.A DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-945-9333
Mailing Address - Street 1:995 N MIAMI BEACH BLVD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3721
Mailing Address - Country:US
Mailing Address - Phone:305-945-9333
Mailing Address - Fax:305-945-9444
Practice Address - Street 1:995 N MIAMI BEACH BLVD
Practice Address - Street 2:SUITE 137
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3721
Practice Address - Country:US
Practice Address - Phone:305-945-9333
Practice Address - Fax:305-945-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty