Provider Demographics
NPI:1679783450
Name:MAYORAL, OSVALDO
Entity type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:
Last Name:MAYORAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 SW 74 COURT
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-670-8088
Mailing Address - Fax:305-670-2154
Practice Address - Street 1:8950 SW 74 COURT
Practice Address - Street 2:SUITE 1212
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-670-8088
Practice Address - Fax:305-670-2154
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice