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General NPI Number Information
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NPI Number | 1659936656
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Entity Type | Organization
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Legal Business Name | PEMBROKE DENTAL & SPA PL
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 15671 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1204
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Country | US
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Telephone | 954-419-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 21239 NE 31ST AVE
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City | AVENTURA
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State | FL
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Zip | 33180-3907
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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 | AUTHORIZED OFFICIAL
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Name | JEANETTE NOVARA
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Credential | DMD
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Telephone | 786-488-3507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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