Provider Demographics
NPI:1053996629
Name:PEDRAJA, MILAIDYS (DMD)
Entity type:Individual
Prefix:DR
First Name:MILAIDYS
Middle Name:
Last Name:PEDRAJA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 SW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2239
Mailing Address - Country:US
Mailing Address - Phone:786-797-1280
Mailing Address - Fax:
Practice Address - Street 1:5607 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-2826
Practice Address - Country:US
Practice Address - Phone:305-805-1700
Practice Address - Fax:305-805-1715
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26449122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program