Healthcare Provider Details

I. General information

NPI: 1245152057
Provider Name (Legal Business Name): WESTLAKE PEDIATRIC DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 SEMINOLE PRATT WHITNEY RD UNIT 1600
WESTLAKE FL
33470-0045
US

IV. Provider business mailing address

8499 NW 14TH CT
CORAL SPRINGS FL
33071-6208
US

V. Phone/Fax

Practice location:
  • Phone: 847-757-8033
  • Fax:
Mailing address:
  • Phone: 847-757-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL DAVID GRUZMARK
Title or Position: OWNER
Credential: DMD
Phone: 847-757-8033