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General NPI Number Information
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NPI Number | 1972752830
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Entity Type | Organization
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Legal Business Name | ONSITE DENTAL RESPONSE LLC.
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1205 N.DIXIE HWY.
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City | LAKE WORTH
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State | FL
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Zip | 33460-2122
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Country | US
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Telephone | 561-802-4446
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Fax | 561-802-9997
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Provider Business Mailing Address
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Address Line | 1205 N.DIXIE HWY.
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City | LAKE WORTH
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State | FL
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Zip | 33460-2122
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Country | US
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Telephone | 561-802-4446
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Fax | 561-802-9997
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS ANTHONY DEMERE
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Credential |
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Telephone | 561-802-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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