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General NPI Number Information
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NPI Number | 1639729627
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Entity Type | Organization
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Legal Business Name | COOPER CITY FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 5900 HIATUS RD STE 300
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City | COOPER CITY
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State | FL
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Zip | 33330-4527
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Country | US
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Telephone | 954-252-8257
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 HIATUS RD STE 300
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City | COOPER CITY
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State | FL
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Zip | 33330-4527
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MIKE RESPOL
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Credential |
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Telephone | 954-252-8257
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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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