=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316672553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANICE DEFELICE DMD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2022
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 S DIXIE HWY
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-3883
-----------------------------------------------------
Fax | 954-454-1901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 S DIXIE HWY
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-542-6644
-----------------------------------------------------
Fax | 954-454-1901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JANICE ROUSSELLE DEFELICE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 305-542-6644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------