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General NPI Number Information
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NPI Number | 1922077650
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Entity Type | Organization
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Legal Business Name | DENTAQUEST OF FLORIDA, INC.
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 2100 PONCE DE LEON BLVD SUITE 950
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City | CORAL GABLES
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State | FL
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Zip | 33134-5215
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Country | US
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Telephone | 305-443-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 PONCE DE LEON BLVD. SUITE 950
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 800-417-7140
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. STEVEN J. POLLOCK
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Credential |
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Telephone | 800-417-7140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 67016
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License Number State | FL
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