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General NPI Number Information
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NPI Number | 1962769810
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND ADULT DENTISTRY OF THE PALM BEACHES PLLC
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 3365 BURNS ROAD SUITE 209
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4308
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Country | US
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Telephone | 561-775-1011
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Fax | 561-775-8283
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Provider Business Mailing Address
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Address Line | 3365 BURNS ROAD SUITE 209
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4308
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Country | US
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Telephone | 561-775-1011
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Fax | 561-775-8283
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Authorized Official
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Title or Position | PARTNER
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Name | YURI GOLDVASSER
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Credential | D.D.S.
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Telephone | 561-775-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN16968
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16980
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License Number State | FL
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