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General NPI Number Information
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NPI Number | 1770354847
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Entity Type | Organization
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Legal Business Name | JET DENTAL OF FLORIDA PLLC
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 3479 NE 163RD ST STE 1184
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4426
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Country | US
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Telephone | 801-430-9262
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Fax | 801-430-9262
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Provider Business Mailing Address
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Address Line | 1881 W TRAVERSE PKWY STE E102
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City | LEHI
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State | UT
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Zip | 84043-5986
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Country | US
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Telephone | 801-430-9262
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Fax | 801-430-9262
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Authorized Official
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Title or Position | OWNER
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Name | JERRY I BRATMAN
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Credential | DDS
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Telephone | 561-495-8181
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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 |
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License Number State |
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Taxonomy #2
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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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