Provider Demographics
NPI:1912280603
Name:TAMIAMI DENTAL CENTER, PA
Entity Type:Organization
Organization Name:TAMIAMI DENTAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GABBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-553-9655
Mailing Address - Street 1:13232 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1176
Mailing Address - Country:US
Mailing Address - Phone:305-553-9655
Mailing Address - Fax:305-553-9688
Practice Address - Street 1:13232 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1176
Practice Address - Country:US
Practice Address - Phone:305-553-9655
Practice Address - Fax:305-553-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16637261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN19023OtherLICENSE
FLDN15661OtherLICENSE
FLDN19051OtherLICENSE
FLDN16385OtherLICENSE
FLDN16637OtherLICENSE