Provider Demographics
NPI:1316113996
Name:FLAGLER DENTAL CLINIC OF MIAMI, INC.
Entity type:Organization
Organization Name:FLAGLER DENTAL CLINIC OF MIAMI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ORTEGA
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-554-4304
Mailing Address - Street 1:11373 W FLAGLER ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4203
Mailing Address - Country:US
Mailing Address - Phone:305-554-4304
Mailing Address - Fax:305-554-4326
Practice Address - Street 1:11373 W FLAGLER ST
Practice Address - Street 2:SUITE 214
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4203
Practice Address - Country:US
Practice Address - Phone:305-554-4304
Practice Address - Fax:305-554-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty