Illustradent Key Biscayne Pllc

NPI 1114305018 - Dentist - 122300000X

NPI Details
NPI 1114305018
Enumeration Date 05/11/2015
Last Updated 12/22/2015
Entity Type Healthcare Provider
Active Over 1 year ago
Authorized Information
Name MARA MARA
Position MANAGING MEMBER
Phone (305) 361-5493
Fax
Practice Location
240 CRANDON BLVD
SUITE 104
KEY BISCAYNE FL, 33149-1543, US
Phone (305) 361-5493
Fax
Business Location
236 WOODLANDS RD
HARRISON NY, 10528-1322, US
Phone (305) 361-5493
Fax
Toxanomy
Taxonomy Code 122300000X
License State Florida
License Number DN18909
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According to our database, Illustradent Key Biscayne Pllc NPI is 1114305018, taxonomy code is 122300000X and license number is DN18909, license state is located at Florida. Illustradent Key Biscayne Pllc physically located at 240 Crandon Blvd, Key Biscayne FL, 33149-1543. NPI Number 1033115704 has the healthcare provider type.

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1114305018 NPI number is provided on an as is basis without warranty of any kind. 1114305018 is maintained by the National Plan & Provider Enumeration System. The contents of Illustradent Key Biscayne Pllc are for informational purposes only.