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General NPI Number Information
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NPI Number | 1063018687
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Entity Type | Organization
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Legal Business Name | AMERICAN PEDIATRIC DENTAL LAKE WORTH, INC
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1708 N FEDERAL HWY
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City | LAKE WORTH
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State | FL
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Zip | 33460-6668
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Country | US
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Telephone | 954-417-1337
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Fax | 954-998-4750
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Provider Business Mailing Address
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Address Line | 1708 N FEDERAL HWY
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City | LAKE WORTH
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State | FL
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Zip | 33460-6668
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Country | US
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Telephone | 954-417-1337
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Fax | 954-998-4750
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Authorized Official
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Title or Position | INSURANCE DIRECTOR
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Name | LOURDES KONTOS
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Credential |
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Telephone | 954-417-1337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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