Healthcare Provider Details

I. General information

NPI: 1285280024
Provider Name (Legal Business Name): DLC DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 W OAKLAND PARK BLVD
SUNRISE FL
33313-1214
US

IV. Provider business mailing address

4400 NW 30TH ST APT 127
COCONUT CREEK FL
33066-2135
US

V. Phone/Fax

Practice location:
  • Phone: 954-742-7995
  • Fax:
Mailing address:
  • Phone: 954-594-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOROTIE LACROZE
Title or Position: PRESIDENT
Credential: DMD
Phone: 954-594-6454