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General NPI Number Information
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NPI Number | 1780128033
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Entity Type | Organization
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Legal Business Name | PALM BEACH COSMETIC DENTISTRY
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 2150 LAKE IDA RD SUITE #8
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2443
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Country | US
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Telephone | 561-272-4110
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Fax | 561-272-4174
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Provider Business Mailing Address
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Address Line | 2150 LAKE IDA RD SUITE #8
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2443
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Country | US
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Telephone | 561-272-4110
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Fax | 561-272-4174
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Authorized Official
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Title or Position | COO
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Name | DR. TIFFANY MONCRIEFFE
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Credential | DMD
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Telephone | 718-801-0187
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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 | DN21023
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License Number State | FL
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