Provider Demographics
NPI:1396965661
Name:GL DENTAL CLINIC PA
Entity type:Organization
Organization Name:GL DENTAL CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-448-3896
Mailing Address - Street 1:780 NW 42ND AVENUE
Mailing Address - Street 2:SUITE 424
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:305-448-3896
Mailing Address - Fax:305-442-2225
Practice Address - Street 1:780 NW 42ND AVENUE
Practice Address - Street 2:SUITE 424
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126
Practice Address - Country:US
Practice Address - Phone:305-448-3896
Practice Address - Fax:305-442-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty