Provider Demographics
NPI:1336551134
Name:MIAMI CENTER FOR ORTHODONTICS L.L.C
Entity type:Organization
Organization Name:MIAMI CENTER FOR ORTHODONTICS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-223-0110
Mailing Address - Street 1:14660 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8065
Mailing Address - Country:US
Mailing Address - Phone:305-223-0110
Mailing Address - Fax:305-225-0065
Practice Address - Street 1:14660 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8065
Practice Address - Country:US
Practice Address - Phone:305-223-0110
Practice Address - Fax:305-225-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 159731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty