MEDICARE: DENTAL TEAM OF BOYNTON

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1548836422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL TEAM OF BOYNTON

Provider Business Mailing Address
First Line	:	2826 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 W BOYNTON BEACH BLVD STE 2
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3654
Country	:	US
Telephone Number	:	561-736-1700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT RODRIGUEZ
Credential	:
Telephone Number	:	954-776-4720

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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Directions to “DENTAL TEAM OF BOYNTON ” Practice Location

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