Provider Demographics
NPI:1114461456
Name:ASSOCIATED DENTAL PROFESSIONALS PLLC
Entity Type:Organization
Organization Name:ASSOCIATED DENTAL PROFESSIONALS PLLC
Other - Org Name:APPEARANCE IMPLANT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-999-9650
Mailing Address - Street 1:951 BROKEN SOUND PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:561-999-9650
Mailing Address - Fax:561-431-8169
Practice Address - Street 1:6390 W INDIANTOWN RD
Practice Address - Street 2:SUITE 32
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4607
Practice Address - Country:US
Practice Address - Phone:561-250-6307
Practice Address - Fax:561-431-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty