Provider Demographics
NPI:1124120241
Name:FLORIDIAN DENTAL CARE
Entity type:Organization
Organization Name:FLORIDIAN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:EGUSQUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-693-8888
Mailing Address - Street 1:158 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3991
Mailing Address - Country:US
Mailing Address - Phone:305-887-7179
Mailing Address - Fax:305-887-7179
Practice Address - Street 1:7900 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4902
Practice Address - Country:US
Practice Address - Phone:305-693-8888
Practice Address - Fax:305-693-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN11915OtherDENTIST LICENSE
FLBE9697181OtherDEA NUMBER