Provider Demographics
NPI:1144871799
Name:PAYA DENTAL
Entity type:Organization
Organization Name:PAYA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-502-4467
Mailing Address - Street 1:2851 W 68TH ST STE 12
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1799
Mailing Address - Country:US
Mailing Address - Phone:786-502-4467
Mailing Address - Fax:786-536-4795
Practice Address - Street 1:2851 W 68TH ST STE 12
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1799
Practice Address - Country:US
Practice Address - Phone:786-502-4467
Practice Address - Fax:786-536-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015054900Medicaid