Healthcare Provider Details

I. General information

NPI: 1003732157
Provider Name (Legal Business Name): AVS DENTAL LOUNGE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W PALMETTO PARK RD STE 504
BOCA RATON FL
33433-3425
US

IV. Provider business mailing address

7000 W PALMETTO PARK RD STE 504
BOCA RATON FL
33433-3425
US

V. Phone/Fax

Practice location:
  • Phone: 561-563-8404
  • Fax:
Mailing address:
  • Phone: 561-563-8404
  • Fax:

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: FILIBERTO JOSE HERDOCIA
Title or Position: PRESIDENT
Credential: DDS
Phone: 561-563-8404