Provider Demographics
NPI:1477442697
Name:PALM AVENUE DENTAL
Entity type:Organization
Organization Name:PALM AVENUE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOHARYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-402-8871
Mailing Address - Street 1:4301 PALM AVE STE F
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4060
Mailing Address - Country:US
Mailing Address - Phone:786-558-4856
Mailing Address - Fax:786-558-4956
Practice Address - Street 1:4301 PALM AVE STE F
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4060
Practice Address - Country:US
Practice Address - Phone:786-558-4856
Practice Address - Fax:786-558-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental