Provider Demographics
NPI:1053606830
Name:VENETO DENTAL CARE
Entity type:Organization
Organization Name:VENETO DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HENAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-430-7789
Mailing Address - Street 1:3600 RED RD
Mailing Address - Street 2:SUITE 604
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6013
Mailing Address - Country:US
Mailing Address - Phone:954-430-7789
Mailing Address - Fax:954-430-6622
Practice Address - Street 1:3600 RED RD
Practice Address - Street 2:SUITE 604
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6013
Practice Address - Country:US
Practice Address - Phone:954-430-7789
Practice Address - Fax:954-430-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1306003488OtherINDIVIDUAL