Provider Demographics
NPI:1174925903
Name:HENAO AND ASSOCIATES DENTAL GROUP
Entity type:Organization
Organization Name:HENAO AND ASSOCIATES DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-570-1777
Mailing Address - Street 1:18300 NW 62ND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8200
Mailing Address - Country:US
Mailing Address - Phone:305-570-1777
Mailing Address - Fax:
Practice Address - Street 1:18300 NW 62ND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-8200
Practice Address - Country:US
Practice Address - Phone:305-570-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 170901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty