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General NPI Number Information
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NPI Number | 1205371259
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Entity Type | Organization
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Legal Business Name | C-BAR DENTAL,LLC
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 1702 S DIXIE HWY SUITE C1
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City | LAKE WORTH
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State | FL
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Zip | 33460-5886
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Country | US
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Telephone | 561-223-3501
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 S DIXIE HWY SUITE C1
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City | LAKE WORTH
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State | FL
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Zip | 33460-5886
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Country | US
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Telephone | 561-223-3501
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Fax |
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Authorized Official
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Title or Position | PRACTICE CONSULTANT MANAGER
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Name | GENESE DEZILME
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Credential |
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Telephone | 561-752-6304
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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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