Provider Demographics
NPI:1093529604
Name:AURA DENTAL FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:AURA DENTAL FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYSBEL
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-485-3317
Mailing Address - Street 1:610 BARNES BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5210
Mailing Address - Country:US
Mailing Address - Phone:347-485-3317
Mailing Address - Fax:
Practice Address - Street 1:3129 PANGEA CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8822
Practice Address - Country:US
Practice Address - Phone:347-485-3317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental