Provider Demographics
NPI:1285267047
Name:DENTAL BLUSH MIAMI PA
Entity type:Organization
Organization Name:DENTAL BLUSH MIAMI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YACELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-553-0666
Mailing Address - Street 1:12260 SW 8TH ST STE 226
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1549
Mailing Address - Country:US
Mailing Address - Phone:305-553-0666
Mailing Address - Fax:305-553-0933
Practice Address - Street 1:12260 SW 8TH ST STE 226
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1549
Practice Address - Country:US
Practice Address - Phone:305-553-0666
Practice Address - Fax:305-553-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750788030OtherDENTAL INSURANCE