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General NPI Number Information
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NPI Number | 1033837133
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Entity Type | Organization
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Legal Business Name | ORMOND FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 1200 W GRANADA BLVD STE 2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8157
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Country | US
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Telephone | 386-275-1792
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Fax | 386-265-0576
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Provider Business Mailing Address
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Address Line | 8495 TWIN LAKE DR
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City | BOCA RATON
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State | FL
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Zip | 33496-1923
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Country | US
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Telephone | 954-397-1452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUES BENCHIMOL
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Credential | DMD
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Telephone | 954-397-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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