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General NPI Number Information
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NPI Number | 1992968721
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Entity Type | Organization
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Legal Business Name | SOUTH DENTAL OF PEMBROKE
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 601 NW 179TH AVE SUITE 101
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2819
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Country | US
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Telephone | 954-450-1303
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Fax | 954-450-5568
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Provider Business Mailing Address
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Address Line | 601 NW 179TH AVE SUITE 101
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2819
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Country | US
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Telephone | 954-450-1303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAHN OPPENHEIMER
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Credential | DDS
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Telephone | 305-388-7599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13563
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License Number State | FL
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