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General NPI Number Information
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NPI Number | 1841721610
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Entity Type | Organization
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Legal Business Name | DENTAL BLISS P.A.
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 9990 NW 6TH CT BAY 16
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6157
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Country | US
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Telephone | 954-534-9651
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Fax | 954-639-7835
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Provider Business Mailing Address
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Address Line | 9990 NW 6TH CT BAY 16
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6157
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Country | US
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Telephone | 954-534-9651
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Fax | 954-639-7835
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. TOSHA RENAE WILLIAMS
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Credential | DDS
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Telephone | 954-534-9651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19661
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License Number State | FL
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