Provider Demographics
NPI:1831395763
Name:NICOMEDES BERASAIN, DDS, PA
Entity type:Organization
Organization Name:NICOMEDES BERASAIN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOMEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERASAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-551-6866
Mailing Address - Street 1:300 SW 107TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3600
Mailing Address - Country:US
Mailing Address - Phone:305-551-6866
Mailing Address - Fax:305-551-2863
Practice Address - Street 1:300 SW 107TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3600
Practice Address - Country:US
Practice Address - Phone:305-551-6866
Practice Address - Fax:305-551-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN007985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty