Healthcare Provider Details

I. General information

NPI: 1891455994
Provider Name (Legal Business Name): DDSC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 SHERIDAN ST
HOLLYWOOD FL
33024-8561
US

IV. Provider business mailing address

9449 SHERIDAN ST
HOLLYWOOD FL
33024-8561
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-9560
  • Fax:
Mailing address:
  • Phone: 954-885-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN ALBERTO CERRUTTI
Title or Position: PRESIDENT/GENERAL DENTIST
Credential: DDS
Phone: 954-885-9560