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General NPI Number Information
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NPI Number | 1114255015
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Entity Type | Organization
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Legal Business Name | HEALTHY FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 5350 W HILLSBORO BLVD SUITE 201
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4396
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Country | US
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Telephone | 954-478-0858
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Fax |
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Provider Business Mailing Address
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Address Line | 5350 W HILLSBORO BLVD SUITE 201
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4396
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Country | US
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Telephone | 954-478-0858
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT - DENTIST
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Name | DR. MANUEL IGNACIO CRUCES
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Credential | D.D.S.
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Telephone | 954-478-0858
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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 | DN18716
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License Number State | FL
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