Healthcare Provider Details

I. General information

NPI: 1962017582
Provider Name (Legal Business Name): 1 STEP DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 BERACASA WAY STE 203
BOCA RATON FL
33433-3444
US

IV. Provider business mailing address

7025 BERACASA WAY STE 203
BOCA RATON FL
33433-3444
US

V. Phone/Fax

Practice location:
  • Phone: 561-465-3784
  • Fax: 561-430-3419
Mailing address:
  • Phone: 561-465-3784
  • Fax: 561-430-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CESAR OCHOA
Title or Position: MANAGER
Credential:
Phone: 561-465-3784