Healthcare Provider Details

I. General information

NPI: 1972089431
Provider Name (Legal Business Name): PLANTATION DENTAL AND ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NW 70TH AVE STE 104
PLANTATION FL
33317-2360
US

IV. Provider business mailing address

300 NW 70TH AVE STE 104
PLANTATION FL
33317-2360
US

V. Phone/Fax

Practice location:
  • Phone: 954-327-8075
  • Fax:
Mailing address:
  • Phone: 954-327-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER COLETTI
Title or Position: OWNER
Credential:
Phone: 954-327-8075