Provider Demographics
NPI:1164639977
Name:THE CENTER FOR COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:THE CENTER FOR COSMETIC DENTISTRY
Other - Org Name:THE SPA FOR COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LECONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-691-9498
Mailing Address - Street 1:2000 PGA BLVD STE 3120
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2718
Mailing Address - Country:US
Mailing Address - Phone:561-691-9498
Mailing Address - Fax:561-691-9308
Practice Address - Street 1:2000 PGA BLVD STE 3120
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408-2718
Practice Address - Country:US
Practice Address - Phone:561-691-9498
Practice Address - Fax:561-691-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty