MEDICARE: KA DENTAL GROUP RPB, 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
1	122300000X	Dentist	DN19874	FL

General Provider Information

NPI Number	:	1871919266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KA DENTAL GROUP RPB, PA

Provider Business Mailing Address
First Line	:	1236 ROYAL PALM BEACH BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 ROYAL PALM BEACH BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1602
Country	:	US
Telephone Number	:	561-795-1404
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KRUNAL PATEL
Credential	:
Telephone Number	:	973-767-3283

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	03/10/2014

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