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General NPI Number Information
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NPI Number | 1093806028
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Entity Type | Organization
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Legal Business Name | PLANTATION DENTAL ASSOCIATES, PL
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10080 NW 1ST CT
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City | PLANTATION
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State | FL
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Zip | 33324-7035
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Country | US
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Telephone | 954-474-8977
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Fax | 954-474-8946
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Provider Business Mailing Address
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Address Line | 10080 NW 1ST CT
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City | PLANTATION
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State | FL
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Zip | 33324-7035
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Country | US
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Telephone | 954-474-8977
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Fax | 954-474-8946
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTIN MARIE DEEDRICK
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Credential |
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Telephone | 954-474-8977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14352
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10331
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17136
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License Number State | FL
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