Provider Demographics
NPI:1427272947
Name:SUPER DENTAL INC
Entity type:Organization
Organization Name:SUPER DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-945-9333
Mailing Address - Street 1:995 N MIAMI BEACH BLVD
Mailing Address - Street 2:SUITE137
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3721
Mailing Address - Country:US
Mailing Address - Phone:305-945-9333
Mailing Address - Fax:305-945-9444
Practice Address - Street 1:995 N MIAMI BEACH BLVD
Practice Address - Street 2:SUITE137
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3721
Practice Address - Country:US
Practice Address - Phone:305-945-9333
Practice Address - Fax:305-945-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL584600-2261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental