Healthcare Provider Details

I. General information

NPI: 1841645249
Provider Name (Legal Business Name): SETH D. POMERANTZ, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201B N PINE ISLAND RD
TAMARAC FL
33321-1500
US

IV. Provider business mailing address

8201B N PINE ISLAND RD
TAMARAC FL
33321-1500
US

V. Phone/Fax

Practice location:
  • Phone: 954-726-4511
  • Fax: 954-726-5248
Mailing address:
  • Phone: 954-726-4511
  • Fax: 954-726-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14357
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17459
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11264
License Number StateFL

VIII. Authorized Official

Name: DR. SETH D. POMERANTZ
Title or Position: OWNER
Credential: DMD
Phone: 954-726-4511