Provider Demographics
NPI:1295291185
Name:LICE NOT NICE LLC
Entity type:Organization
Organization Name:LICE NOT NICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-569-1377
Mailing Address - Street 1:8680 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3734
Mailing Address - Country:US
Mailing Address - Phone:786-534-7277
Mailing Address - Fax:
Practice Address - Street 1:8680 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3734
Practice Address - Country:US
Practice Address - Phone:786-534-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL247200000XOtherTECHNICIAN, OTHER
FL193400000XOtherSINGLE SPECIALTY GROUP
FL99203OtherLICE TREATMENT