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General NPI Number Information
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NPI Number | 1003285339
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTISTRY SOUTH FLORIDA SEPCIALISTS LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 15340 JOG RD STE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2170
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Country | US
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Telephone | 561-495-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 15340 JOG RD STE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2170
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Country | US
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Telephone | 561-495-2099
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KELLI CARTER STALLER
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Credential |
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Telephone | 561-495-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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