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General NPI Number Information
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NPI Number | 1902553357
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY OF JENSEN BEACH PLLC
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Dates
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Enumeration Date | 03/06/2022
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Last Update Date | 03/06/2022
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Provider Practice Location Address
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Address Line | 3571 NW FEDERAL HWY
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4454
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Country | US
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Telephone | 772-444-0601
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Fax | 772-444-3371
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Provider Business Mailing Address
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Address Line | 8794 W BOYNTON BEACH BLVD STE 218
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-4469
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Country | US
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Telephone | 561-789-6611
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SEAN TOMALTY
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Credential | DMD
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Telephone | 561-789-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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