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General NPI Number Information
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NPI Number | 1225839996
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Entity Type | Organization
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Legal Business Name | GENTLE TEETH AND BRACES OF COOPER CITY PA
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 5900 HIATUS RD STE 100
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City | FORT LAUDERDALE
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State | FL
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Zip | 33330-4527
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Country | US
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Telephone | 954-228-7886
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Fax | 954-271-2509
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Provider Business Mailing Address
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Address Line | 5900 HIATUS RD STE 100
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City | FORT LAUDERDALE
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State | FL
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Zip | 33330-4527
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Country | US
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Telephone | 954-228-7886
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Fax | 954-271-2509
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Authorized Official
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Title or Position | CFO
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Name | MRS. SYDNEE SAMUEL
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Credential |
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Telephone | 954-997-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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