Active NPI
Daniel De la Fuente Balboa, DMD
- Dentist
- Miami, FL
National Provider Identifier
1023677283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN24143
- Practice address
- 12350 SW 127TH Ave
Miami, FL 33186-6595 - Phone
- (305) 232-2227
- NPI assigned
- Jun 11, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN24143 | FL | Primary |
Addresses
Primary practice location
12350 SW 127TH Ave
Miami, FL 33186-6595
Mailing address
6060 SW 62ND PL
South Miami, FL 33143-2170
Phone (786) 234-7051
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN24143 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kendall Dental Care | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Miami, FL
- NPI 1114125192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1023677283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6060 SW 62ND PL",
"city": "SOUTH MIAMI",
"state": "FL",
"postal_code": "331432170",
"telephone_number": "786-234-7051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12350 SW 127TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331866595",
"telephone_number": "305-232-2227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LA FUENTE BALBOA",
"first_name": "DANIEL",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-11",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "FL",
"license": "DN24143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.