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General NPI Number Information
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NPI Number | 1134856719
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Entity Type | Organization
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Legal Business Name | CODENTAL GROUP LLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 4047 OKEECHOBEE BLVD STE 219
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3237
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Country | US
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Telephone | 561-908-1423
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Fax |
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Provider Business Mailing Address
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Address Line | 12434 QUERCUS LN
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City | WELLINGTON
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State | FL
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Zip | 33414-4126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. YANELIS PEREZ
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Credential |
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Telephone | 561-640-7600
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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 |
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License Number State |
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