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General NPI Number Information
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NPI Number | 1114262680
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Entity Type | Organization
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Legal Business Name | DOLPHIN DENTAL CARE OF HALLANDALE, L.L.C.
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 660 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4422
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Country | US
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Telephone | 954-316-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 660 E. HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009
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Country | US
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Telephone | 954-316-4444
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | IVAN O PARRA
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Credential | DDS
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Telephone | 954-316-4444
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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 | DN16116
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License Number State | FL
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