Provider Demographics
NPI:1013232511
Name:THE DENTAL GROUP
Entity Type:Organization
Organization Name:THE DENTAL GROUP
Other - Org Name:THE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-485-1170
Mailing Address - Street 1:2609 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1355
Mailing Address - Country:US
Mailing Address - Phone:954-485-1170
Mailing Address - Fax:954-485-5820
Practice Address - Street 1:2609 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1355
Practice Address - Country:US
Practice Address - Phone:954-485-1170
Practice Address - Fax:954-485-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN15860OtherLICENSCE NUMBER