Provider Demographics
NPI:1093806028
Name:PLANTATION DENTAL ASSOCIATES, PL
Entity Type:Organization
Organization Name:PLANTATION DENTAL ASSOCIATES, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-474-8977
Mailing Address - Street 1:10080 NW 1ST CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7035
Mailing Address - Country:US
Mailing Address - Phone:954-474-8977
Mailing Address - Fax:954-474-8946
Practice Address - Street 1:10080 NW 1ST CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7035
Practice Address - Country:US
Practice Address - Phone:954-474-8977
Practice Address - Fax:954-474-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL143521223G0001X
FL103311223G0001X
FL171361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty