Provider Demographics
NPI:1215635644
Name:MIAMI DENTAL PARTNERS LLC
Entity type:Organization
Organization Name:MIAMI DENTAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:QUINONES-BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-915-5078
Mailing Address - Street 1:15100 NW 67TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5645 NW 87TH AVE.
Practice Address - Street 2:SUITE 112
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:614-915-5078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty