Provider Demographics
NPI:1912500547
Name:ASTORIA DENTAL AT THE BEACH INC.
Entity Type:Organization
Organization Name:ASTORIA DENTAL AT THE BEACH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:305-467-7490
Mailing Address - Street 1:1235 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3809
Mailing Address - Country:US
Mailing Address - Phone:305-674-0200
Mailing Address - Fax:305-674-7346
Practice Address - Street 1:1235 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3809
Practice Address - Country:US
Practice Address - Phone:305-674-0200
Practice Address - Fax:305-674-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental