Provider Demographics
NPI:1871454710
Name:FLORIDIAN DENTAL AT FORT LAUDERDALE, LLC
Entity type:Organization
Organization Name:FLORIDIAN DENTAL AT FORT LAUDERDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:MOSS
Authorized Official - Last Name:VINUELA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-493-6556
Mailing Address - Street 1:4542 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5204
Mailing Address - Country:US
Mailing Address - Phone:957-493-6556
Mailing Address - Fax:
Practice Address - Street 1:4542 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5204
Practice Address - Country:US
Practice Address - Phone:957-493-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty