Provider Demographics
NPI:1568848257
Name:SOUTH MIAMI DENTAL SERVICES PA
Entity type:Organization
Organization Name:SOUTH MIAMI DENTAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PILAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-320-8247
Mailing Address - Street 1:9100 SOUTH DADELAND BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-667-2633
Mailing Address - Fax:
Practice Address - Street 1:9100 SOUTH DADELAND BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-667-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty