| Organization Name: | SOUTH MIAMI DENTAL SERVICE PA |
| NPI Number: | 1104274471 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAYRA V PEREZ (ADMNISTRATOR) |
| Mailing Address: | 240 Crandon Blvd Suite 104 Key Biscayne |
| State: | FL US |
| Postal Code: | 33149 |
| Phone Number: | 3053610351 |
| Fax Number: | 3053612180 |
| NPI Enumeration Date: | 05/27/2016 |
| NPI Last Update Date: | 05/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | DN18909 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |