=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366715716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIKE PEDIATRIC DENTISTRY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2012
-----------------------------------------------------
Last Update Date | 02/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1865 NW BOCA RATON BLVD STE 102
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-347-7006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1865 NW BOCA RATON BLVD STE 102
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-347-7006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. TALIA PIKE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 954-856-9955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DN17596
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------