Provider Demographics
NPI:1134784267
Name:MIGHTY CHILDREN'S DENTISTRY
Entity type:Organization
Organization Name:MIGHTY CHILDREN'S DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:BULA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-301-9853
Mailing Address - Street 1:13280 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5425
Mailing Address - Country:US
Mailing Address - Phone:786-301-9853
Mailing Address - Fax:954-688-3414
Practice Address - Street 1:5850 CORAL RIDGE DR STE 101B
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3379
Practice Address - Country:US
Practice Address - Phone:786-301-9853
Practice Address - Fax:954-688-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty