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General NPI Number Information
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NPI Number | 1508241951
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Entity Type | Organization
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Legal Business Name | HOUSE OF DENTISTRY
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 1314 NE 13TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1829
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Country | US
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Telephone | 813-476-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 NE 26TH ST #107
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City | WILTON MANORS
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State | FL
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Zip | 33305-1206
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Country | US
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Telephone | 813-476-2919
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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. TIMOTHY BRYAN HOUSE
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Credential | DMD
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Telephone | 813-476-2919
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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 | DN 18733
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License Number State | FL
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