Provider Demographics
NPI:1972513133
Name:FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:FAMILY & COSMETIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:GOMARA
Authorized Official - Last Name:SALCINES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-243-2438
Mailing Address - Street 1:125 NE 8TH ST
Mailing Address - Street 2:SUIT # 1
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4676
Mailing Address - Country:US
Mailing Address - Phone:786-243-2438
Mailing Address - Fax:305-247-5744
Practice Address - Street 1:125 NE 8TH ST
Practice Address - Street 2:SUIT # 1
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4676
Practice Address - Country:US
Practice Address - Phone:786-243-2438
Practice Address - Fax:305-247-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19768OtherASURANT PROVIDER NUMBER
FL909OtherMCNA FACILITY NUMBER
FL42108OtherADI PROVIDER NUMBER