Healthcare Provider Details

I. General information

NPI: 1972752830
Provider Name (Legal Business Name): ONSITE DENTAL RESPONSE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N.DIXIE HWY.
LAKE WORTH FL
33460-2122
US

IV. Provider business mailing address

1205 N.DIXIE HWY.
LAKE WORTH FL
33460-2122
US

V. Phone/Fax

Practice location:
  • Phone: 561-802-4446
  • Fax: 561-802-9997
Mailing address:
  • Phone: 561-802-4446
  • Fax: 561-802-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS ANTHONY DEMERE
Title or Position: PRESIDENT
Credential:
Phone: 561-802-4446