MEDICARE: IDENTAL OF DELRAY BEACH, PLLC

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	122300000X	Dentist	DN16932	FL

General Provider Information

NPI Number	:	1750803896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDENTAL OF DELRAY BEACH, PLLC

Provider Business Mailing Address
First Line	:	1507 LYONS RD
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-3934
Country	:	US
Telephone Number	:	954-974-4101
Fax Number	:	561-381-3323

Provider Business Practice Location Address
First Line	:	4993 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3850
Country	:	US
Telephone Number	:	561-381-3100
Fax Number	:	561-381-3323

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	MICHAEL FLOYD BATTLE
Credential	:	DDS
Telephone Number	:	727-327-5561

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	09/03/2020

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