Provider Demographics
NPI:1376643791
Name:DENTAL HEALTH GROUP
Entity type:Organization
Organization Name:DENTAL HEALTH GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-652-6313
Mailing Address - Street 1:20295 NW 2ND AVE
Mailing Address - Street 2:210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2550
Mailing Address - Country:US
Mailing Address - Phone:305-652-6313
Mailing Address - Fax:305-652-9940
Practice Address - Street 1:1261 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4003
Practice Address - Country:US
Practice Address - Phone:305-858-2545
Practice Address - Fax:305-858-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN102191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty