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General NPI Number Information
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NPI Number | 1538427158
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL PLACE OF EAST BOCA,INC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 509 NE 20TH ST
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City | BOCA RATON
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State | FL
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Zip | 33431-8141
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Country | US
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Telephone | 954-849-4143
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Fax |
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Provider Business Mailing Address
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Address Line | 509 NE 20TH ST
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City | BOCA RATON
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State | FL
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Zip | 33431-8141
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Country | US
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Telephone | 954-849-4143
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOSEPH HERMAN
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Credential |
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Telephone | 954-849-4143
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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 | DN13586
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License Number State | FL
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