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General NPI Number Information
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NPI Number | 1679020408
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Entity Type | Organization
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Legal Business Name | PERFECTION DENTAL SPA
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7744 PETERS RD
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City | PLANTATION
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State | FL
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Zip | 33324-4004
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Country | US
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Telephone | 954-951-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 7744 PETERS RD
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City | PLANTATION
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State | FL
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Zip | 33324-4004
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Country | US
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Telephone | 954-951-0181
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA LEWIS-MCKENZIE
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Credential | D.M.D
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Telephone | 954-951-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN20754
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License Number State | FL
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