=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427313881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TSAR DENTAL EXCELLENCE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2012
-----------------------------------------------------
Last Update Date | 07/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 VILLAGE BLVD SUITE 304
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-833-2364
-----------------------------------------------------
Fax | 561-471-1831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 VILLAGE BLVD SUITE 304
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-833-2364
-----------------------------------------------------
Fax | 561-471-1831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NATALIA TSAR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 561-833-2364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN16466
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN16455
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------