Provider Demographics
NPI:1093213233
Name:AFFORDABLE DENTAL CENTER OF WEST BROWARD
Entity Type:Organization
Organization Name:AFFORDABLE DENTAL CENTER OF WEST BROWARD
Other - Org Name:MY DENTIST FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-578-6869
Mailing Address - Street 1:11941 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2224
Mailing Address - Country:US
Mailing Address - Phone:954-578-6869
Mailing Address - Fax:
Practice Address - Street 1:11941 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-2224
Practice Address - Country:US
Practice Address - Phone:954-578-6869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15321261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174703300OtherNPI (INDIVIDUAL)