Provider Demographics
NPI:1871682914
Name:MLV DENTAL MEDICAL MANAGEMENT CO
Entity type:Organization
Organization Name:MLV DENTAL MEDICAL MANAGEMENT CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOPETON
Authorized Official - Middle Name:ADOLPH
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-948-0456
Mailing Address - Street 1:995 NE 167ST. STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH,
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-948-0456
Mailing Address - Fax:305-948-0458
Practice Address - Street 1:995 NE 167ST. STE 100
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH,
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-948-0456
Practice Address - Fax:305-948-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty