Provider Demographics
NPI:1811166838
Name:PRIA, CARLOS (DMD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PRIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3795
Mailing Address - Country:US
Mailing Address - Phone:305-576-6611
Mailing Address - Fax:786-476-2819
Practice Address - Street 1:3601 FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3795
Practice Address - Country:US
Practice Address - Phone:305-576-6611
Practice Address - Fax:786-476-2818
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL192491223P0300X
FLDN195491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019578700Medicaid