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General NPI Number Information
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NPI Number | 1801449095
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL GROUP AND ASSOCIATES PA
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 1249 N STATE ROAD 7
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City | LAUDERHILL
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State | FL
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Zip | 33313-5801
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Country | US
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Telephone | 954-584-2214
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Fax |
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Provider Business Mailing Address
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Address Line | 11897 PRESERVATION LN
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City | BOCA RATON
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State | FL
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Zip | 33498-6231
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Country | US
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Telephone |
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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. ILYA STEIN
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Credential | DMD
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Telephone | 305-915-0567
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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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