STG Dental Care Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STG DENTAL CARE CORP

Practice address

508 E 49TH St
Hialeah, FL 33013-1962

Phone

(786) 458-5605

NPI assigned

Sep 2, 2020

Organization subpart

No

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

Authorized official

Name

Eladio Miguel Traviesas Herrera, DDSNPI 1992187876

Title

Owner

Phone

(305) 826-8980

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eladio Miguel Traviesas Herrera

  • Dentist
  • Hialeah, FL
  • NPI 1992187876
  Authorized official Same address or phone

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702512000000",
    "number": "1104430511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 PALM AVE STE F",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330124060",
            "telephone_number": "786-458-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 E 49TH ST",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330131962",
            "telephone_number": "786-458-5605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STG DENTAL CARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A",
        "authorized_official_last_name": "TRAVIESAS HERRERA",
        "authorized_official_first_name": "ELADIO",
        "authorized_official_middle_name": "MIGUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-826-8980",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.