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General NPI Number Information
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NPI Number | 1851554000
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Entity Type | Organization
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Legal Business Name | DENTASTIC DENTAL CENTER
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 31 SE 24TH AVE STE 3
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City | POMPANO BEACH
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State | FL
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Zip | 33062-5347
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Country | US
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Telephone | 954-781-4670
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Fax |
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Provider Business Mailing Address
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Address Line | 31 SE 24TH AVE STE 3
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City | POMPANO BEACH
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State | FL
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Zip | 33062-5347
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Country | US
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Telephone | 954-781-4670
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PAUL SHEPARD
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Credential | PA
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Telephone | 954-464-1098
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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 | DN 18328
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License Number State | FL
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