Provider Demographics
NPI:1770318784
Name:PRIVILEGE DENTAL STUDIO LLC
Entity type:Organization
Organization Name:PRIVILEGE DENTAL STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LAPEYRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-849-8971
Mailing Address - Street 1:5700 BISCAYNE BLVD APT 607
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2670
Mailing Address - Country:US
Mailing Address - Phone:305-849-8971
Mailing Address - Fax:
Practice Address - Street 1:601 N FEDERAL HWY STE 404
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2463
Practice Address - Country:US
Practice Address - Phone:305-849-8971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty