Healthcare Provider Details

I. General information

NPI: 1508084609
Provider Name (Legal Business Name): DEERFIELD CENTER FOR DENTAL SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W HILLSBORO BLVD #211
DEERFIELD BEACH FL
33442-1484
US

IV. Provider business mailing address

1800 W HILLSBORO BLVD #211
DEERFIELD BEACH FL
33442-1484
US

V. Phone/Fax

Practice location:
  • Phone: 954-427-4287
  • Fax: 954-427-5540
Mailing address:
  • Phone: 954-427-4287
  • Fax: 954-427-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number08490
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number15174
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13518
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14521
License Number StateFL

VIII. Authorized Official

Name: JODI PONCE
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-427-4287