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General NPI Number Information
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NPI Number | 1306727060
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Entity Type | Organization
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Legal Business Name | G&G PRESTIGE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 10689 WILES RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-2014
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Country | US
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Telephone | 954-345-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 6936 LONG PINE CIR
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3079
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Country | US
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Telephone | 305-956-8363
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JORGE JULIO GONZALEZ TEJADA
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Credential | DMD
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Telephone | 305-956-8363
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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 |
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License Number State |
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