Provider Demographics
NPI:1093733024
Name:EDUARDO NORTHLAND,D.D.S.,P.A.
Entity type:Organization
Organization Name:EDUARDO NORTHLAND,D.D.S.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-1172
Mailing Address - Street 1:2825 S.W. 22 STREET
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3203
Mailing Address - Country:US
Mailing Address - Phone:305-448-1172
Mailing Address - Fax:305-446-2724
Practice Address - Street 1:2825 S.W. 22 STREET
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3203
Practice Address - Country:US
Practice Address - Phone:305-448-1172
Practice Address - Fax:305-446-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00123771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty