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Moderna Smile Of Sunset Corp

Clinic/Center, Dental in Miami, FL. Organization (NPI-2).

NPI number1699366641
StatusActive
Last updated in NPPESFeb 2, 2021

Details

NPI
1699366641
Entity type
Organization (NPI-2)
Legal business name
Moderna Smile Of Sunset Corp
Organization subpart
No
Enumeration date
Feb 2, 2021
Certification date
Feb 2, 2021
Last updated
Feb 2, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental––Yes

Practice location

10728 Sw 72nd St
Miami, FL 33173-2702

Phone 305-596-7155

Mailing address

5246 Sw 8th St
Coral Gables, FL 33134-2375

Authorized official

Juan Carlos Izquierdo
President
3055967155

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