Provider Demographics
NPI:1053828434
Name:DENTAL ART & SPA LLC
Entity Type:Organization
Organization Name:DENTAL ART & SPA LLC
Other - Org Name:THE INTERNATIONAL CENTER FOR ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ODILA
Authorized Official - Last Name:MAGALHAES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-922-0052
Mailing Address - Street 1:2900 N MILITARY TRL STE 175
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6381
Mailing Address - Country:US
Mailing Address - Phone:561-922-0052
Mailing Address - Fax:561-300-7134
Practice Address - Street 1:2900 N MILITARY TRL STE 175
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6381
Practice Address - Country:US
Practice Address - Phone:561-922-0052
Practice Address - Fax:561-300-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-07
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21861261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental