Provider Demographics
NPI:1871990069
Name:AESTHETIC DENTISTRY OF SOUTH MIAMI
Entity type:Organization
Organization Name:AESTHETIC DENTISTRY OF SOUTH MIAMI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-667-7543
Mailing Address - Street 1:7600 SW 57TH AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5428
Mailing Address - Country:US
Mailing Address - Phone:305-667-7543
Mailing Address - Fax:
Practice Address - Street 1:7600 SW 57TH AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5428
Practice Address - Country:US
Practice Address - Phone:305-667-7543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN95991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty