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General NPI Number Information
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NPI Number | 1477672475
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Entity Type | Organization
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Legal Business Name | BANYAN DENTAL GROUP, L.L.C.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 1820 58TH AVE SUITE 101
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City | VERO BEACH
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State | FL
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Zip | 32966-4673
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Country | US
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Telephone | 772-567-2132
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 58TH AVE SUITE 101
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City | VERO BEACH
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State | FL
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Zip | 32966-4673
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Country | US
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Telephone | 772-567-2132
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE HOFFMAN
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Credential | D.D.S.
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Telephone | 772-567-2132
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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 |
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License Number State |
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