Provider Demographics
NPI:1528858206
Name:AVADENTMIAMI PA
Entity type:Organization
Organization Name:AVADENTMIAMI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBNIV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-600-5454
Mailing Address - Street 1:3765 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4104
Mailing Address - Country:US
Mailing Address - Phone:305-600-5454
Mailing Address - Fax:305-949-3449
Practice Address - Street 1:3765 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4104
Practice Address - Country:US
Practice Address - Phone:305-600-5454
Practice Address - Fax:305-949-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty