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General NPI Number Information
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NPI Number | 1124387311
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL PLACE OF BOCA RATON,INC
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 20401S. S.R. #7 G-14
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City | BOCA RATON
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State | FL
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Zip | 33498
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Country | US
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Telephone | 561-470-1109
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Fax |
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Provider Business Mailing Address
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Address Line | 20401S. S.R. #7 STE.G-14
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City | BOCA RATON
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State | FL
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Zip | 33498
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Country | US
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Telephone | 561-470-1109
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JOSEPH HERMAN
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Credential |
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Telephone | 954-849-4143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13586
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License Number State | FL
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