=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497635080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH FLORIDA DENTAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7522 WILES RD STE B104
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-755-7971
-----------------------------------------------------
Fax | 954-755-7994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7522 WILES RD STE B104
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-755-7971
-----------------------------------------------------
Fax | 954-755-7994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIEL COHEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 954-755-7971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------