Provider Demographics
NPI:1184156200
Name:MYRIAM BERRAHIL DMD,PA
Entity type:Organization
Organization Name:MYRIAM BERRAHIL DMD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRAHIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-940-5157
Mailing Address - Street 1:3363 NE 163RD ST
Mailing Address - Street 2:807
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4401
Mailing Address - Country:US
Mailing Address - Phone:305-940-5157
Mailing Address - Fax:786-288-5870
Practice Address - Street 1:3363 NE 163RD ST
Practice Address - Street 2:807
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4401
Practice Address - Country:US
Practice Address - Phone:305-940-5157
Practice Address - Fax:786-288-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty