Healthcare Provider Details

I. General information

NPI: 1780376426
Provider Name (Legal Business Name): DEYAB DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 GATEWAY BLVD STE 101
BOYNTON BEACH FL
33426-8360
US

IV. Provider business mailing address

1034 GATEWAY BLVD STE 101
BOYNTON BEACH FL
33426-8360
US

V. Phone/Fax

Practice location:
  • Phone: 561-249-2585
  • Fax: 561-318-8040
Mailing address:
  • Phone: 561-249-2585
  • Fax: 561-318-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIM DEYAB
Title or Position: OWNER
Credential: DDS
Phone: 561-249-2585