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General NPI Number Information
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NPI Number | 1659013126
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Entity Type | Organization
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Legal Business Name | DENTAL TEAM OF COCONUT CREEK LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1507 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3934
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Country | US
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Telephone | 954-974-4104
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Fax | 954-974-6154
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Provider Business Mailing Address
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Address Line | 1507 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3934
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Country | US
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Telephone | 954-974-4104
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Fax | 954-974-6154
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Authorized Official
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Title or Position | CEO
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Name | ROBERT RODRIGUEZ
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Credential |
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Telephone | 954-516-0606
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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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