Provider Demographics
NPI:1972618361
Name:BALMIR-THEVENIN, JOELLE MARIE (DDS)
Entity type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:MARIE
Last Name:BALMIR-THEVENIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 N KENDALL DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-271-0510
Mailing Address - Fax:305-271-3532
Practice Address - Street 1:10621 N KENDALL DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-271-0510
Practice Address - Fax:305-271-3532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071317100Medicaid