Healthcare Provider Details

I. General information

NPI: 1114818051
Provider Name (Legal Business Name): BROWARD PEDIATRIC DENTISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 SHERIDAN ST STE E
HOLLYWOOD FL
33021-3552
US

IV. Provider business mailing address

4420 SHERIDAN ST STE E
HOLLYWOOD FL
33021-3552
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-8311
  • Fax:
Mailing address:
  • Phone: 954-962-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL CAMACHO
Title or Position: VICE PRESIDENT
Credential: DMD
Phone: 954-962-8311