Provider Demographics
NPI:1124363676
Name:DENTALMED ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DENTALMED ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-505-7631
Mailing Address - Street 1:12600 PEMBROKE RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2544
Mailing Address - Country:US
Mailing Address - Phone:954-505-7631
Mailing Address - Fax:954-505-7633
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:SUITE 314
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-505-7631
Practice Address - Fax:954-505-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130291223E0200X
FLDN142841223G0001X
FLDN143451223P0300X
FLDN-142841223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty