Provider Demographics
NPI:1841432234
Name:UNIVERSAL DENTAL CLINIC INC
Entity type:Organization
Organization Name:UNIVERSAL DENTAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-326-7159
Mailing Address - Street 1:432 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1021
Mailing Address - Country:US
Mailing Address - Phone:305-326-7159
Mailing Address - Fax:305-324-5875
Practice Address - Street 1:432 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1021
Practice Address - Country:US
Practice Address - Phone:305-326-7159
Practice Address - Fax:305-324-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental