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General NPI Number Information
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NPI Number | 1467990986
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Entity Type | Organization
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Legal Business Name | IDENTAL OF COCONUT CREEK, PLLC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 1507 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3934
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Country | US
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Telephone | 954-974-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3934
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Country | US
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Telephone | 954-974-4101
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | MICHAEL FLOYD BATTLE
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Credential | DDS
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Telephone | 727-327-5561
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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 | DN16932
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License Number State | FL
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