Basic Information
| Provider Information | |||||||||
| NPI: | 1568758498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANAKA | ||||||||
| FirstName: | MIYUKI | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 PARK CENTRE BLVD | ||||||||
| Address2: | 100 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056210023 | ||||||||
| FaxNumber: | 3056239188 | ||||||||
| Practice Location | |||||||||
| Address1: | 5961 NW 173RD DR | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330155114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055567500 | ||||||||
| FaxNumber: | 3055033476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH 20536 | FL | Y | Dental Providers | Dental Hygienist |
No ID Information.