1225839996 NPI number — GENTLE TEETH AND BRACES OF COOPER CITY PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225839996 NPI number — GENTLE TEETH AND BRACES OF COOPER CITY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENTLE TEETH AND BRACES OF COOPER CITY PA
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:
Provider Other Organization Name Type Code:
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:
1225839996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 HIATUS RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33330-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-228-7886
Provider Business Mailing Address Fax Number:
954-271-2509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 HIATUS RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33330-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-228-7886
Provider Business Practice Location Address Fax Number:
954-271-2509
Provider Enumeration Date:
03/20/2025

Additional Information

Authorized Official

Authorized Official Last Name:
SAMUEL
Authorized Official First Name:
SYDNEE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
954-997-9779

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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