MEDICARE: HERON BAY DENTAL ASSOCIATES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN11976	FL

General Provider Information

NPI Number	:	1487872230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERON BAY DENTAL ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	5960 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3302
Country	:	US
Telephone Number	:	954-255-5550
Fax Number	:	954-755-8276

Provider Business Practice Location Address
First Line	:	5960 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3302
Country	:	US
Telephone Number	:	954-255-5550
Fax Number	:	954-755-8276

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEITH MARLOWE FRIEFELD
Credential	:	D.D.S.
Telephone Number	:	954-255-5550

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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