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General NPI Number Information
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NPI Number | 1508104597
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Entity Type | Organization
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Legal Business Name | AA DENTAL PLLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 113 SW 11TH CT SUITE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-1271
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Country | US
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Telephone | 954-463-7972
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Fax | 954-764-5916
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Provider Business Mailing Address
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Address Line | 113 SW 11 CT SUITE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315
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Country | US
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Telephone | 954-463-7972
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Fax | 954-764-5916
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | ALLISON ALEXANDER
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Credential | DMD
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Telephone | 954-463-7972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN16636
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN18817
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License Number State | FL
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