Provider Demographics
NPI:1114255015
Name:HEALTHY FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:HEALTHY FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:CRUCES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-478-0858
Mailing Address - Street 1:5350 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4396
Mailing Address - Country:US
Mailing Address - Phone:954-478-0858
Mailing Address - Fax:
Practice Address - Street 1:5350 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4396
Practice Address - Country:US
Practice Address - Phone:954-478-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18716261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental