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General NPI Number Information
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NPI Number | 1710502554
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Entity Type | Organization
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Legal Business Name | DIRECT DENTAL SOLUTIONS NORTH PLLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 18331 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1421
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Country | US
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Telephone | 954-937-1840
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Fax | 888-417-3216
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Provider Business Mailing Address
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Address Line | 18331 PINES BLVD # 206
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1421
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Country | US
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Telephone | 888-417-3211
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Fax | 888-417-3216
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELLEN F VARGAS
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Credential | DMD
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Telephone | 561-308-5854
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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 |
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License Number State |
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