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General NPI Number Information
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NPI Number | 1821781667
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Entity Type | Individual
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Provider Name | ANDREW PELOQUIN DMD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 11800 S MILITARY TRL STE 102
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City | GOLF
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State | FL
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Zip | 33436-5501
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Country | US
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Telephone | 401-241-0310
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 W HILLSBORO BLVD # 201
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4401
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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 |
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Name |
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Credential |
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Telephone |
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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 | DN27922
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License Number State | FL
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