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General NPI Number Information
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NPI Number | 1457088916
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Entity Type | Organization
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Legal Business Name | DENTAL IMPLANT 24HRS PEMBROKE PINES LLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD STE 420
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6443
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Country | US
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Telephone | 954-697-4533
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Fax |
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Provider Business Mailing Address
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Address Line | 8250 SW 180TH ST
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City | PALMETTO BAY
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State | FL
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Zip | 33157-6130
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Country | US
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Telephone | 786-229-0698
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSE ALBERTO
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Credential | DDS
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Telephone | 786-683-0698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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