Provider Demographics
NPI:1154087740
Name:DENTIST IN PALM BEACH GARDENS, P.A
Entity Type:Organization
Organization Name:DENTIST IN PALM BEACH GARDENS, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-795-7668
Mailing Address - Street 1:11903 SOUTHERN BLVD
Mailing Address - Street 2:STE #116
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-795-7668
Mailing Address - Fax:561-771-4284
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:#206
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-795-7668
Practice Address - Fax:561-771-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty