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General NPI Number Information
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NPI Number | 1205104809
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Entity Type | Organization
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Legal Business Name | TONGUE TIE CENTER OF FLORIDA
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 3365 BURNS RD STE 200
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4303
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Country | US
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Telephone | 561-944-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 3365 BURNS RD STE 200
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4303
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Country | US
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Telephone | 561-944-9009
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YURI GOLDVASSER
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Credential | DDS
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Telephone | 561-775-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN16968
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License Number State | FL
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