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General NPI Number Information
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NPI Number | 1790050417
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Entity Type | Organization
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Legal Business Name | WEST SIDE PEDIATRIC DENTISTRY PA
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 16223 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33027-4572
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Country | US
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Telephone | 954-433-4544
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Fax | 954-433-4312
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Provider Business Mailing Address
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Address Line | 16223 MIRAMAR PARKWAY
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-433-4544
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Fax | 954-433-4312
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH A. FERRER
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Credential | DMD
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Telephone | 954-433-4544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN15146
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License Number State | FL
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