Provider Demographics
NPI:1073680161
Name:SOUTH FLORIDA DENTISTRY FOR CHILDREN, P.A.
Entity Type:Organization
Organization Name:SOUTH FLORIDA DENTISTRY FOR CHILDREN, P.A.
Other - Org Name:SOUTH FLORIDA DENTISTRY FOR CHILDREN & ORTHODONTICS, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/SOUTH FLORIDA DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-752-7651
Mailing Address - Street 1:10188 NW 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-752-7651
Mailing Address - Fax:954-345-4188
Practice Address - Street 1:10188 NW 31ST STREET
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-752-7651
Practice Address - Fax:954-345-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82771223P0221X
FL151031223P0221X
FLDN177681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty