Provider Demographics
NPI:1750390266
Name:DENTAL DIAGNOSTIC SCANNING & IMAGING
Entity type:Organization
Organization Name:DENTAL DIAGNOSTIC SCANNING & IMAGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-513-8457
Mailing Address - Street 1:10305 NW 41ST ST
Mailing Address - Street 2:SUITE #: 207
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2396
Mailing Address - Country:US
Mailing Address - Phone:305-513-8457
Mailing Address - Fax:
Practice Address - Street 1:10305 NW 41ST ST
Practice Address - Street 2:SUITE #: 207
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2396
Practice Address - Country:US
Practice Address - Phone:305-513-8457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory