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NPI Code Detail

MEDICARE: FL DENTAL GROUP

MEDICARE: FL DENTAL GROUP
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
11223P0300XPeriodontics
21223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1750951299
Entity Type Code : Organization
Provider Name (Legal Business Name) : FL DENTAL GROUP
Provider Business Mailing Address
First Line : 4765 W ATLANTIC AVE
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33445-3838
Country : US
Telephone Number : 561-859-5052
Fax Number : 954-374-6955
Provider Business Practice Location Address
First Line : 4765 W ATLANTIC AVE
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33445-3838
Country : US
Telephone Number : 561-859-5052
Fax Number : 954-374-6955
Authorized Official
Title or Position : CEO
Name : MS. VICTORIA SAMUELSON
Credential :
Telephone Number : 561-859-5052
Provider Enumeration Date : 06/28/2021
Last Update Date : 07/10/2023

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Directions to “FL DENTAL GROUP ” Practice Location

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