Provider Demographics
NPI:1457990277
Name:CANCER DENTAL SPECIALISTS, PA
Entity Type:Organization
Organization Name:CANCER DENTAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-742-7175
Mailing Address - Street 1:11301 S DIXIE HWY UNIT 565664
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33256-7234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8900 N KENDALL DRIVE
Practice Address - Street 2:MIAMI CANCER INSTITUTE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:786-527-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty