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General NPI Number Information
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NPI Number | 1689289621
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Entity Type | Organization
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Legal Business Name | ALAN D SHOOPAK DMD ORTHODONTIC GROUP II LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 2161 E COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3810
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Country | US
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Telephone | 954-751-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 6311 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-7511
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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 | PRESIDENT OWNER
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Name | ALAN DAVID SHOOPAK
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Credential |
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Telephone | 727-561-7666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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