Advanced Dental Wellness Center
Dentist in Fort Lauderdale, FL. Organization (NPI-2).
NPI number1730694191
StatusActive
Last updated in NPPESDec 7, 2017
Details
- NPI
- 1730694191
- Entity type
- Organization (NPI-2)
- Legal business name
- Advanced Dental Wellness Center
- Organization subpart
- No
- Enumeration date
- Dec 7, 2017
- Last updated
- Dec 7, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DN21039 | FL | Yes |
Practice location
104 Se 1st StFort Lauderdale, FL 33301-1924
Phone 954-525-5662 · Fax 954-525-5251
Mailing address
104 Se 1st StFort Lauderdale, FL 33301-1924
Phone 954-525-5662
Authorized official
Boris Lipovetskiy
Owner
9545255662
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