Provider Demographics
NPI:1124567821
Name:B&R DENTAL FLORIDA CORPORATION
Entity Type:Organization
Organization Name:B&R DENTAL FLORIDA CORPORATION
Other - Org Name:JACARANDA DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-812-9919
Mailing Address - Street 1:751 LEIGH PALM AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-8252
Mailing Address - Country:US
Mailing Address - Phone:954-812-9919
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3166
Practice Address - Country:US
Practice Address - Phone:954-812-9919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty