Provider Demographics
NPI:1154726230
Name:DENTAL CLINIC LLC
Entity type:Organization
Organization Name:DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:ADAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-895-6590
Mailing Address - Street 1:527 NE 124TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5423
Mailing Address - Country:US
Mailing Address - Phone:305-895-6590
Mailing Address - Fax:305-895-9274
Practice Address - Street 1:527 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5423
Practice Address - Country:US
Practice Address - Phone:305-895-6590
Practice Address - Fax:305-895-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty