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General NPI Number Information
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NPI Number | 1164248282
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Entity Type | Organization
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Legal Business Name | GRACE DENTAL INC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 650 W BOYNTON BEACH BLVD STE 2
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3654
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Country | US
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Telephone | 561-282-2500
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Fax | 561-282-2503
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Provider Business Mailing Address
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Address Line | 650 W BOYNTON BEACH BLVD STE 2
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3654
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Country | US
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Telephone | 561-282-2500
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Fax | 561-282-2503
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Authorized Official
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Title or Position | DENTIST
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Name | HELEN PAVON POZO
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Credential | DMD
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Telephone | 786-797-1189
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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 |
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License Number State |
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