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General NPI Number Information
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NPI Number | 1467583229
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Entity Type | Organization
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Legal Business Name | PERIODONTICS OF THE PALM BEACHES, P.A.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 1897 PALM BEACH LAKES BLVD SUITE 215
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3507
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Country | US
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Telephone | 561-686-2477
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Fax | 561-686-2699
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Provider Business Mailing Address
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Address Line | 1897 PALM BEACH LAKES BLVD SUITE 215
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3507
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Country | US
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Telephone | 561-686-2477
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Fax | 561-686-2699
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Authorized Official
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Title or Position | OWNER-PERIODONTIST
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Name | DR. STUART A. FELDMAN
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Credential | D.D.S.
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Telephone | 561-686-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 5191
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License Number State | FL
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