Provider Demographics
NPI:1386509891
Name:PERFECT SMILE AT DADELAND CORP.
Entity type:Organization
Organization Name:PERFECT SMILE AT DADELAND CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIVEISYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-337-1013
Mailing Address - Street 1:9580 SW 40TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4065
Mailing Address - Country:US
Mailing Address - Phone:786-631-3761
Mailing Address - Fax:
Practice Address - Street 1:9580 SW 40TH ST STE A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4065
Practice Address - Country:US
Practice Address - Phone:786-631-3761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-17
Last Update Date:2025-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty