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General NPI Number Information
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NPI Number | 1619636867
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Entity Type | Organization
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Legal Business Name | VITAL DENTAL CENTER OF POMPANO PLLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 2700 NE 14TH STREET CSWY
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3561
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Country | US
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Telephone | 954-781-6170
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Fax | 954-781-6725
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Provider Business Mailing Address
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Address Line | 2700 NE 14TH STREET CSWY
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3561
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Country | US
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Telephone | 954-781-6170
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Fax | 954-781-6725
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN A MAYA
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Credential |
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Telephone | 954-781-6170
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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 |
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License Number State |
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