Provider Demographics
NPI:1003198474
Name:NORTH PALM BEACH DENTISTRY
Entity Type:Organization
Organization Name:NORTH PALM BEACH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-290-1636
Mailing Address - Street 1:700 US HIGHWAY 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4500
Mailing Address - Country:US
Mailing Address - Phone:561-290-1636
Mailing Address - Fax:561-536-4646
Practice Address - Street 1:700 US HIGHWAY 1
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4500
Practice Address - Country:US
Practice Address - Phone:561-290-1636
Practice Address - Fax:561-536-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty