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General NPI Number Information
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NPI Number | 1386265346
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Entity Type | Organization
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Legal Business Name | EAST COMMERCIAL CHILDRENS DENTAL
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 2633 E COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4135
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Country | US
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Telephone | 888-601-4884
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SE 6TH AVE STE 201
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5185
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Country | US
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Telephone | 772-204-3529
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT RODRIGUEZ
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Credential | MBA
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Telephone | 772-204-3529
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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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