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General NPI Number Information
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NPI Number | 1285257048
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Entity Type | Organization
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Legal Business Name | VILLAGE SQUARE DENTAL PLLC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 1601 N HIATUS RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-2129
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Country | US
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Telephone | 954-432-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 N HIATUS RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-2129
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Country | US
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Telephone | 954-432-8100
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Fax |
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Authorized Official
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Title or Position | DDS/OWNER
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Name | ANDREW FORREST
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Credential |
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Telephone | 954-432-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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