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General NPI Number Information
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NPI Number | 1053732735
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDODONTICS OF WELLINGTON
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 3319 STATE ROAD 7 SUITE 307
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City | WELLINGTON
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State | FL
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Zip | 33449-8094
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Country | US
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Telephone | 561-333-2522
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Fax | 561-333-2484
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Provider Business Mailing Address
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Address Line | 3319 STATE ROAD 7 SUITE 307
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City | WELLINGTON
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State | FL
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Zip | 33449-8094
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Country | US
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Telephone | 561-333-2522
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Fax | 561-333-2484
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. NATALIA ROUD
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Credential |
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Telephone | 561-333-2522
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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 | 15484
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License Number State | FL
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