Provider Demographics
NPI:1144879925
Name:VIMO, BELEN NATALIA (DDS)
Entity type:Individual
Prefix:
First Name:BELEN
Middle Name:NATALIA
Last Name:VIMO
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 1:4358 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5208
Mailing Address - Country:US
Mailing Address - Phone:754-265-7845
Mailing Address - Fax:
Practice Address - Street 1:1 GLEN ROYAL PKWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5287
Practice Address - Country:US
Practice Address - Phone:305-847-9915
Practice Address - Fax:954-953-1417
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV500074916910OtherFL DRIVERS LICENSE