Moderna Smile of Galloway Corp

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MODERNA SMILE OF GALLOWAY CORP

Practice address

8718 SW 72ND St
Miami, FL 33173-3512

Phone

(305) 273-9330

NPI assigned

Feb 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Juan Carlos Izquierdo, DMD

Title

President

Phone

(305) 273-9330

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1104417153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5246 SW 8TH ST",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331342375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8718 SW 72ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331733512",
            "telephone_number": "305-273-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERNA SMILE OF GALLOWAY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "IZQUIERDO",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "CARLOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-273-9330",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modern Dental by Smile, PA
• Modern Dental Center, PA
• Modern Med Centers LLC
• Modern Psychology
• Modern Urology Group LLC (Modern Urology)
• Moderna Smile of Kendall Corp
• Moderna Smile of Sunset Corp
• Modernwellnesssolutions PLLC
• Bipte Vijay Modi, MD
• Karina Moenck

• Dental Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.