Provider Demographics
NPI:1083945984
Name:PB HEALTHCARE SVCS, INC
Entity Type:Organization
Organization Name:PB HEALTHCARE SVCS, INC
Other - Org Name:PALM COAST FAMILY DENTISTRY & MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARMINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-445-0977
Mailing Address - Street 1:50 CYPRESS POINT PKWY
Mailing Address - Street 2:SUITE A3
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2500
Mailing Address - Country:US
Mailing Address - Phone:386-445-0977
Mailing Address - Fax:386-445-0579
Practice Address - Street 1:50 CYPRESS POINT PKWY
Practice Address - Street 2:SUITE A3
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2500
Practice Address - Country:US
Practice Address - Phone:386-445-0977
Practice Address - Fax:386-445-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16698122300000X
FLME101528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty