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General NPI Number Information
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NPI Number | 1164639977
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR COSMETIC DENTISTRY
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2000 PGA BLVD STE 3120
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408-2718
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Country | US
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Telephone | 561-691-9498
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Fax | 561-691-9308
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Provider Business Mailing Address
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Address Line | 2000 PGA BLVD STE 3120
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408-2718
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Country | US
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Telephone | 561-691-9498
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Fax | 561-691-9308
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK LECONTE
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Credential | D.M.D
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Telephone | 561-691-9498
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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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