Provider Demographics
NPI:1861783623
Name:NEW ERA DENTAL, P.A
Entity type:Organization
Organization Name:NEW ERA DENTAL, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-558-8637
Mailing Address - Street 1:2011 W 62ND STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2657
Mailing Address - Country:US
Mailing Address - Phone:786-558-8637
Mailing Address - Fax:786-558-8638
Practice Address - Street 1:2011 W 62ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2657
Practice Address - Country:US
Practice Address - Phone:786-558-8637
Practice Address - Fax:786-558-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL621210B88261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental