Healthcare Provider Details

I. General information

NPI: 1770354847
Provider Name (Legal Business Name): JET DENTAL OF FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3479 NE 163RD ST STE 1184
NORTH MIAMI BEACH FL
33160-4426
US

IV. Provider business mailing address

1881 W TRAVERSE PKWY STE E102
LEHI UT
84043-5986
US

V. Phone/Fax

Practice location:
  • Phone: 801-430-9262
  • Fax: 801-430-9262
Mailing address:
  • Phone: 801-430-9262
  • Fax: 801-430-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERRY I BRATMAN
Title or Position: OWNER
Credential: DDS
Phone: 561-495-8181