Healthcare Provider Details

I. General information

NPI: 1114461456
Provider Name (Legal Business Name): ASSOCIATED DENTAL PROFESSIONALS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6390 W INDIANTOWN RD SUITE 32
JUPITER FL
33458-4607
US

IV. Provider business mailing address

951 BROKEN SOUND PKWY SUITE 250
BOCA RATON FL
33487-3507
US

V. Phone/Fax

Practice location:
  • Phone: 561-250-6307
  • Fax: 561-431-8169
Mailing address:
  • Phone: 561-999-9650
  • Fax: 561-431-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WADE HARROUFF
Title or Position: OWNER
Credential: DDS
Phone: 561-999-9650