Provider Demographics
NPI:1154500502
Name:FLORIDA CENTER FOR ESTHETIC DENTISTRY, P.A
Entity Type:Organization
Organization Name:FLORIDA CENTER FOR ESTHETIC DENTISTRY, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-752-5560
Mailing Address - Street 1:9825 W SAMPLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4040
Mailing Address - Country:US
Mailing Address - Phone:954-752-5560
Mailing Address - Fax:954-752-5561
Practice Address - Street 1:9825 W SAMPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4040
Practice Address - Country:US
Practice Address - Phone:954-752-5560
Practice Address - Fax:954-752-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16794261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental