Provider Demographics
NPI:1073110177
Name:CORAL SPRINGS DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:CORAL SPRINGS DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-485-1000
Mailing Address - Street 1:4765 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3838
Mailing Address - Country:US
Mailing Address - Phone:954-718-3384
Mailing Address - Fax:561-431-2468
Practice Address - Street 1:2029 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6132
Practice Address - Country:US
Practice Address - Phone:954-787-1000
Practice Address - Fax:561-413-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty