Provider Demographics
NPI:1447901582
Name:DENTAL ADVANTAGE SOUTH LLC
Entity type:Organization
Organization Name:DENTAL ADVANTAGE SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-379-8019
Mailing Address - Street 1:8650 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2338
Mailing Address - Country:US
Mailing Address - Phone:786-379-8019
Mailing Address - Fax:
Practice Address - Street 1:33497 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-5642
Practice Address - Country:US
Practice Address - Phone:305-874-7509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental