Healthcare Provider Details

I. General information

NPI: 1609442664
Provider Name (Legal Business Name): DENTAL TEAM OF ATLANTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E ATLANTIC BLVD FL 2
POMPANO BEACH FL
33060-6768
US

IV. Provider business mailing address

2826 E OAKLAND PARK BLVD
FORT LAUDERDALE FL
33306-1800
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-1992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ROBERT RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 954-776-4720