Provider Demographics
NPI:1427449859
Name:GUANABO DENTAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:GUANABO DENTAL ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-541-5556
Mailing Address - Street 1:801 NW 37TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3882
Mailing Address - Country:US
Mailing Address - Phone:305-541-5556
Mailing Address - Fax:
Practice Address - Street 1:801 NW 37TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3882
Practice Address - Country:US
Practice Address - Phone:305-541-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN138321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty