Healthcare Provider Details

I. General information

NPI: 1154670834
Provider Name (Legal Business Name): DENTAMERICA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 S FLAMINGO RD
COOPER CITY FL
33330-3237
US

IV. Provider business mailing address

5810 S FLAMINGO RD
COOPER CITY FL
33330-3237
US

V. Phone/Fax

Practice location:
  • Phone: 954-434-3229
  • Fax: 954-680-6254
Mailing address:
  • Phone: 954-434-3229
  • Fax: 954-680-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DEBRA ANN LINDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-434-3229