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General NPI Number Information
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NPI Number | 1104450121
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Entity Type | Organization
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Legal Business Name | LW PEDIATRIC DENTISTRY PA
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 6910 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-2978
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Country | US
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Telephone | 561-770-7321
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Fax | 561-725-0762
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Provider Business Mailing Address
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Address Line | 6910 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-2978
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Country | US
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Telephone | 561-770-7321
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Fax | 561-725-0762
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Authorized Official
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Title or Position | OWNER
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Name | DR. DREW POPPER
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Credential | DMD
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Telephone | 203-415-6875
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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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