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General NPI Number Information
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NPI Number | 1205218559
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES OF BOCA RATON
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 7301A W PALMETTO PARK RD STE 303C
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City | BOCA RATON
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State | FL
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Zip | 33433-3457
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Country | US
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Telephone | 561-347-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 7301A W PALMETTO PARK RD STE 303C
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City | BOCA RATON
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State | FL
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Zip | 33433-3457
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Country | US
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Telephone | 561-347-8266
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MICHAEL P COSTABILE
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Credential | DMD
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Telephone | 561-347-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN17978
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License Number State | FL
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