Healthcare Provider Details

I. General information

NPI: 1295898278
Provider Name (Legal Business Name): PETER D CIPORKIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E COMMERCIAL BLVD
FT LAUDERDALE FL
33308-4135
US

IV. Provider business mailing address

2633 E COMMERCIAL BLVD
FT LAUDERDALE FL
33308-4135
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-4720
  • Fax: 954-489-0004
Mailing address:
  • Phone: 954-776-4720
  • Fax: 954-489-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN8036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: