Provider Demographics
NPI:1215518824
Name:PEDIATRIC DENTAL CENTER OF RIVER LANDING
Entity type:Organization
Organization Name:PEDIATRIC DENTAL CENTER OF RIVER LANDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-353-9887
Mailing Address - Street 1:1440 NW NORTH RIVER DR STE 345
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2894
Mailing Address - Country:US
Mailing Address - Phone:786-368-6212
Mailing Address - Fax:
Practice Address - Street 1:1440 NW NORTH RIVER DR STE 345
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2894
Practice Address - Country:US
Practice Address - Phone:786-368-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty