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General NPI Number Information
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NPI Number | 1275041154
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Entity Type | Organization
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Legal Business Name | 601 DENTAL STUDIO PA
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Dates
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Enumeration Date | 01/13/2018
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Last Update Date | 01/13/2018
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD STE 415
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1012
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Country | US
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Telephone | 954-438-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 601 N FLAMINGO RD STE 415
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NADJA A HORST
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Credential | DMD
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Telephone | 954-895-4398
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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 | DN15676
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License Number State | FL
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