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General NPI Number Information
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NPI Number | 1831477629
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Entity Type | Organization
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Legal Business Name | FLORIDA INSTITUTE FOR PERIODONTICS & DENTAL IMPLANTS, P.A.
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 1515 N FLAGLER DR SUITE 301
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3428
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Country | US
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Telephone | 561-655-1700
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Fax | 561-853-0793
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Provider Business Mailing Address
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Address Line | 1515 N FLAGLER DR SUITE 301
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3428
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Country | US
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Telephone | 561-655-1700
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Fax | 561-853-0793
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. ROBERT HOLT
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Credential | D.M.D.
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Telephone | 561-655-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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