Provider Demographics
NPI:1427298587
Name:ADVANCED AESTHETIC DENTISTRY OF KENDALL
Entity type:Organization
Organization Name:ADVANCED AESTHETIC DENTISTRY OF KENDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-552-1553
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-552-1553
Mailing Address - Fax:305-552-7329
Practice Address - Street 1:11880 SW 40TH STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3574
Practice Address - Country:US
Practice Address - Phone:305-552-1553
Practice Address - Fax:305-552-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty