Provider Demographics
NPI:1083893721
Name:SUPERIOR DENTAL INC
Entity Type:Organization
Organization Name:SUPERIOR DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICAHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:954-583-4447
Mailing Address - Street 1:660 NORTH STATE ROAD 7
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2117
Mailing Address - Country:US
Mailing Address - Phone:954-583-4447
Mailing Address - Fax:954-583-8641
Practice Address - Street 1:660 NORTH STATE ROAD 7
Practice Address - Street 2:SUITE 12
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2117
Practice Address - Country:US
Practice Address - Phone:954-583-4447
Practice Address - Fax:954-583-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN97891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty