1073680161 NPI number — SOUTH FLORIDA DENTISTRY FOR CHILDREN, P.A.

Table of content: (NPI 1073680161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073680161 NPI number — SOUTH FLORIDA DENTISTRY FOR CHILDREN, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA DENTISTRY FOR CHILDREN, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH FLORIDA DENTISTRY FOR CHILDREN & ORTHODONTICS, P.A.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073680161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10188 NW 31ST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-752-7651
Provider Business Mailing Address Fax Number:
954-345-4188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10188 NW 31ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-752-7651
Provider Business Practice Location Address Fax Number:
954-345-4188
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT/SOUTH FLORIDA DENTISTRY
Authorized Official Telephone Number:
954-752-7651

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  8277 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 15103 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: DN17768 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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