Provider Demographics
NPI:1952113631
Name:CROWN DENTISTRY LLC
Entity type:Organization
Organization Name:CROWN DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-4589
Mailing Address - Street 1:3408 W 84TH ST STE 217
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4943
Mailing Address - Country:US
Mailing Address - Phone:305-512-4589
Mailing Address - Fax:
Practice Address - Street 1:3217 VINELAND RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4907
Practice Address - Country:US
Practice Address - Phone:407-655-4700
Practice Address - Fax:407-279-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty