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General NPI Number Information
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NPI Number | 1386401495
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Entity Type | Organization
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Legal Business Name | BOYNTON MALL MODERN DENTISTRY, PA
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 701 N CONGRESS AVE STE 2B
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3418
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Country | US
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Telephone | 561-210-1883
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Fax | 561-228-4066
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 561-210-1883
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Fax | 561-228-4066
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER K TOLMIE
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Credential | DDS
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Telephone | 561-210-1883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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