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General NPI Number Information
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NPI Number | 1699214015
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Entity Type | Organization
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Legal Business Name | CHOICE DENTAL CARE LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 2536 N STATE ROAD 7
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3205
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Country | US
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Telephone | 954-983-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 W 16TH AVE SUITE 200
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City | HIALEAH
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State | FL
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Zip | 33012-7189
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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
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Name | JOELYZ PATINO
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Credential | DMD, PA
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Telephone | 786-691-1110
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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 | DN 18786
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License Number State | FL
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