Healthcare Provider Details

I. General information

NPI: 1962906339
Provider Name (Legal Business Name): BMB DENTAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 LAKE VICTORIA GARDENS AVE STE 2201
PALM BEACH GARDENS FL
33410-2764
US

IV. Provider business mailing address

11701 LAKE VICTORIA GARDENS AVE STE 2201
PALM BEACH GARDENS FL
33410-2764
US

V. Phone/Fax

Practice location:
  • Phone: 561-623-9935
  • Fax:
Mailing address:
  • Phone: 561-623-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MATUTE
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 561-623-9935