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General NPI Number Information
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NPI Number | 1023514098
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Entity Type | Organization
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Legal Business Name | OAKLAND PARK FAMILY DENTAL PA
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2901 W OKLND PRK BLVD
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City | OAKLAND PARK
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State | FL
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Zip | 33311-1243
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Country | US
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Telephone | 954-484-4374
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 W OAKLANDPARK BLVD B-21
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City | OAKLANPARK
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State | FL
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Zip | 33311
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Country | US
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Telephone | 954-484-4374
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC MINGEL
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Credential |
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Telephone | 954-484-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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