Provider Demographics
NPI:1730686833
Name:DENTAL EXCELLENCE PARTNERS LLC
Entity type:Organization
Organization Name:DENTAL EXCELLENCE PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-417-8516
Mailing Address - Street 1:13920 SW 47TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4405
Mailing Address - Country:US
Mailing Address - Phone:786-408-6651
Mailing Address - Fax:786-706-1738
Practice Address - Street 1:13920 SW 47TH ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4405
Practice Address - Country:US
Practice Address - Phone:786-408-6651
Practice Address - Fax:786-706-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid