Provider Demographics
NPI:1376348581
Name:ADONIAS PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:ADONIAS PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHAREVBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-398-8818
Mailing Address - Street 1:5600 BLUE LAGOON DR STE 12AND13
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2369
Mailing Address - Country:US
Mailing Address - Phone:786-438-4744
Mailing Address - Fax:
Practice Address - Street 1:5600 BLUE LAGOON DR STE 12AND13
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2369
Practice Address - Country:US
Practice Address - Phone:786-438-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty