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General NPI Number Information
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NPI Number | 1700132271
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL DENTISTRY, INC.
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 1411 N FLAGLER DR #4100
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3404
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Country | US
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Telephone | 561-685-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 9751 E BAY HARBOR DR #1204
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City | BAY HARBOR ISLANDS
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State | FL
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Zip | 33154-3830
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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 | CEO
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Name | BURT JORDAN
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Credential |
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Telephone | 561-685-7020
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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 | 6848
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License Number State | FL
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