Provider Demographics
NPI:1669743761
Name:DENTAL ADVANTAGE ADMINISTRATION
Entity type:Organization
Organization Name:DENTAL ADVANTAGE ADMINISTRATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACAYO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:305-642-0003
Mailing Address - Street 1:3383 NW 7TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4140
Mailing Address - Country:US
Mailing Address - Phone:305-642-0003
Mailing Address - Fax:305-642-0009
Practice Address - Street 1:3383 NW 7TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4140
Practice Address - Country:US
Practice Address - Phone:305-642-0003
Practice Address - Fax:305-642-0009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL ADVANTAGE ADMINISTRATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL193561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty