Provider Demographics
NPI:1205516473
Name:MICROENDODONTICS SPECIALTY CENTER
Entity type:Organization
Organization Name:MICROENDODONTICS SPECIALTY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-374-9215
Mailing Address - Street 1:302 NW 179TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2818
Mailing Address - Country:US
Mailing Address - Phone:954-374-9215
Mailing Address - Fax:
Practice Address - Street 1:302 NW 179TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2818
Practice Address - Country:US
Practice Address - Phone:954-374-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty