Provider Demographics
NPI:1164467361
Name:DENTACARE DENTAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:DENTACARE DENTAL ASSOCIATES, PA
Other - Org Name:DENTACARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIETTIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-475-9455
Mailing Address - Street 1:101 N PINE ISLAND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1843
Mailing Address - Country:US
Mailing Address - Phone:954-475-9455
Mailing Address - Fax:954-475-9931
Practice Address - Street 1:101 N PINE ISLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1843
Practice Address - Country:US
Practice Address - Phone:954-475-9455
Practice Address - Fax:954-475-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty