Provider Demographics
NPI:1386175404
Name:HIALEAH CITY DENTAL
Entity type:Organization
Organization Name:HIALEAH CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-242-5777
Mailing Address - Street 1:1544 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4613
Mailing Address - Country:US
Mailing Address - Phone:305-558-9222
Mailing Address - Fax:305-558-9333
Practice Address - Street 1:1544 W 37TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4613
Practice Address - Country:US
Practice Address - Phone:305-558-9222
Practice Address - Fax:305-558-9333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA CITY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14911122300000X
FLDN20945122300000X
FLDN20110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty