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General NPI Number Information
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NPI Number | 1558376079
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Entity Type | Organization
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Legal Business Name | TEQUESTA DENTAL ASSOCIATES, P. A.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 175 TEQUESTA DR SUITE C
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City | TEQUESTA
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State | FL
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Zip | 33469-2733
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Country | US
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Telephone | 561-746-7684
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Fax |
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Provider Business Mailing Address
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Address Line | 175 TEQUESTA DR SUITE C
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City | TEQUESTA
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State | FL
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Zip | 33469-2733
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Country | US
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Telephone | 561-746-7684
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JENNIFER ELIZABETH COLE
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Credential | D.D.S.
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Telephone | 561-746-7684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN0014069
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License Number State | FL
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