Provider Demographics
NPI:1487462362
Name:MIA DENTAL CORP
Entity type:Organization
Organization Name:MIA DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDOR
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:VALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-532-6795
Mailing Address - Street 1:9451 SW 192ND DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7933
Mailing Address - Country:US
Mailing Address - Phone:786-970-9723
Mailing Address - Fax:
Practice Address - Street 1:407 LINCOLN RD STE 700
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3024
Practice Address - Country:US
Practice Address - Phone:305-532-6795
Practice Address - Fax:305-728-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1023742079OtherNPES
FL1194255539OtherNPES