Healthcare Provider Details

I. General information

NPI: 1992656524
Provider Name (Legal Business Name): THE DENTAL LOFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 NE 20TH TER STE 215
FORT LAUDERDALE FL
33308-4510
US

IV. Provider business mailing address

4800 NE 20TH TER STE 215
FORT LAUDERDALE FL
33308-4510
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-1985
  • Fax: 954-999-0962
Mailing address:
  • Phone: 954-399-1985
  • Fax: 954-999-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CESAR JULIAN HERNANDEZ
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 954-399-1985