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General NPI Number Information
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NPI Number | 1154087740
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Entity Type | Organization
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Legal Business Name | DENTIST IN PALM BEACH GARDENS, P.A
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 3385 BURNS RD #206
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410
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Country | US
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Telephone | 561-795-7668
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Fax | 561-771-4284
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Provider Business Mailing Address
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Address Line | 11903 SOUTHERN BLVD STE #116
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411
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Country | US
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Telephone | 561-795-7668
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Fax | 561-771-4284
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. NAREN SIRIVOLO
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Credential |
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Telephone | 561-795-7668
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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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