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General NPI Number Information
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NPI Number | 1740756501
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Entity Type | Organization
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Legal Business Name | LAUDERDALE DENTISTRY FOR KIDS LLC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 4500 N STATE ROAD 7 STE 101
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5868
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Country | US
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Telephone | 954-261-7551
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 N STATE ROAD 7 STE 101
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5868
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Country | US
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Telephone | 954-261-7551
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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. DAVID TIJERINO
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Credential | DDS
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Telephone | 786-637-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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