=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841792777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME DENTISTRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2018
-----------------------------------------------------
Last Update Date | 04/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4515 WILES RD STE 104
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-308-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5851 HOLMBERG RD APT 424
-----------------------------------------------------
City | PARKLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-4521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-308-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. HUGUES JEAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 305-308-3433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------