Provider Demographics
NPI:1316166366
Name:REVUELTA, ANA MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:MARIA
Last Name:REVUELTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W 46TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3283
Mailing Address - Country:US
Mailing Address - Phone:305-558-2933
Mailing Address - Fax:305-558-6970
Practice Address - Street 1:1255 W 46TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3283
Practice Address - Country:US
Practice Address - Phone:305-558-2933
Practice Address - Fax:305-558-6970
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist