1500 Dental LLC
Dentist, Periodontics in Fort Lauderdale, FL. Organization (NPI-2).
NPI number1073002259
StatusActive
Last updated in NPPESMay 3, 2018
Details
- NPI
- 1073002259
- Entity type
- Organization (NPI-2)
- Legal business name
- 1500 Dental LLC
- Organization subpart
- No
- Enumeration date
- May 3, 2018
- Last updated
- May 3, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | DN16336 | FL | Yes |
| 122300000X | Dentist | DN14284 | FL |
Practice location
1500 N Federal Hwy Ste 250Fort Lauderdale, FL 33304-5603
Phone 954-715-1000 · Fax 954-372-1000
Mailing address
1500 N Federal Hwy Ste 250Fort Lauderdale, FL 33304-5603
Phone 954-715-1000 · Fax 954-372-1000
Authorized official
Nekelda A Weiss
Insurance & Credentialing Coordinat
9547151000
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