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General NPI Number Information
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NPI Number | 1164467361
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Entity Type | Organization
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Legal Business Name | DENTACARE DENTAL ASSOCIATES, PA
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 N PINE ISLAND RD SUITE 101
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City | PLANTATION
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State | FL
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Zip | 33324-1843
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Country | US
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Telephone | 954-475-9455
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Fax | 954-475-9931
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Provider Business Mailing Address
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Address Line | 101 N PINE ISLAND RD SUITE 101
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City | PLANTATION
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State | FL
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Zip | 33324-1843
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Country | US
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Telephone | 954-475-9455
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Fax | 954-475-9931
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. LANA C RIETTIE
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Credential | D.D.S.
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Telephone | 954-475-9455
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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 | DN16056
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License Number State | FL
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