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General NPI Number Information
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NPI Number | 1669739801
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Entity Type | Organization
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Legal Business Name | JOHN R. PASQUAL DMD PA
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 4600 LINTON BLVD SUITE 220
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6600
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Country | US
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Telephone | 561-900-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 LINTON BLVD SUITE 220
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6600
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Country | US
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Telephone | 561-900-9080
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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 | RON PASQUAL
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Credential |
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Telephone | 561-900-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN17270
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License Number State | FL
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