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NPI Code Detail

MEDICARE: BAYVIEW DENTAL ASSOC.PA.

MEDICARE: BAYVIEW DENTAL ASSOC.PA.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry10129FL

General Provider Information

NPI Number : 1134232978
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYVIEW DENTAL ASSOC.PA.
Provider Business Mailing Address
First Line : 2633 E COMMERCIAL BLVD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-4135
Country : US
Telephone Number : 954-776-4720
Fax Number :
Provider Business Practice Location Address
First Line : 2633 E COMMERCIAL BLVD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-4135
Country : US
Telephone Number : 954-776-4720
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. PHILIP PINE
Credential :
Telephone Number : 954-776-4720
Provider Enumeration Date : 08/16/2006
Last Update Date : 08/22/2020

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Directions to “BAYVIEW DENTAL ASSOC.PA. ” Practice Location

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