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General NPI Number Information
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NPI Number | 1437536703
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Entity Type | Organization
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Legal Business Name | DENTALWORKS STUDIO OF INDIANTOWN PA
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 15275 SW ADAMS AVE
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City | INDIANTOWN
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State | FL
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Zip | 34956-3433
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Country | US
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Telephone | 772-597-4627
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Fax | 772-597-4630
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Provider Business Mailing Address
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Address Line | 6336 FOREST HILL BLVD
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City | GREENACRES
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State | FL
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Zip | 33415-6104
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Country | US
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Telephone | 561-642-1177
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Fax | 561-642-1143
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLAUDIA J ORTEGA
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Credential | D.M.D.
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Telephone | 561-642-1177
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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 | DN18835
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License Number State | FL
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