Healthcare Provider Details

I. General information

NPI: 1235799131
Provider Name (Legal Business Name): SANITAS DENTAL OF SOUTH FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
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 TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS F BRETON
Title or Position: DENTIST/PRACTICE OWNER
Credential: D.M.D.
Phone: 954-434-3229